Healthcare Provider Details

I. General information

NPI: 1467738310
Provider Name (Legal Business Name): JENNIFER SNOW RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S JANESVILLE ST
MILTON WI
53563-1775
US

IV. Provider business mailing address

5836 N PROMISING LN
MILTON WI
53563-8453
US

V. Phone/Fax

Practice location:
  • Phone: 608-868-6777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12252-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: