Healthcare Provider Details

I. General information

NPI: 1356204382
Provider Name (Legal Business Name): JENNIFER NEIDEEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N86W12999 NIGHTINGALE WAY
MENOMONEE FALLS WI
53051-2102
US

IV. Provider business mailing address

1727 N 71ST ST
WAUWATOSA WI
53213-2345
US

V. Phone/Fax

Practice location:
  • Phone: 262-532-5024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13970-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: