Healthcare Provider Details

I. General information

NPI: 1336763002
Provider Name (Legal Business Name): JENNIFER ENDRES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BUTTERNUT DR STE 100
GREENVILLE SC
29605-4655
US

IV. Provider business mailing address

3 BUTTERNUT DR STE 100
GREENVILLE SC
29605-4655
US

V. Phone/Fax

Practice location:
  • Phone: 864-522-3340
  • Fax:
Mailing address:
  • Phone: 864-522-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number13955
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: