Healthcare Provider Details

I. General information

NPI: 1174844542
Provider Name (Legal Business Name): JENNIFER ANN NANNI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 06/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S MAIN ST
BUTLER PA
16001-5913
US

IV. Provider business mailing address

118 S MAIN ST
BUTLER PA
16001-5913
US

V. Phone/Fax

Practice location:
  • Phone: 724-287-6751
  • Fax:
Mailing address:
  • Phone: 724-287-6751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP035968L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: