Healthcare Provider Details

I. General information

NPI: 1982802344
Provider Name (Legal Business Name): JENNIFER ALLISON DEDERING PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER ALLISON GORES-TODD

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 N 12TH ST
MILWAUKEE WI
53233-1305
US

IV. Provider business mailing address

8508 S DEERWOOD LN
FRANKLIN WI
53132-8006
US

V. Phone/Fax

Practice location:
  • Phone: 414-219-3100
  • Fax:
Mailing address:
  • Phone: 414-304-8697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14144-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: