Healthcare Provider Details

I. General information

NPI: 1568715548
Provider Name (Legal Business Name): JASON JENDERS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N PLANKINTON AVE
MILWAUKEE WI
53203-1802
US

IV. Provider business mailing address

1212 E OGDEN AVE APT 310
MILWAUKEE WI
53202-2932
US

V. Phone/Fax

Practice location:
  • Phone: 414-223-6820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16173-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: