=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003207192
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER LENGER PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2015
-----------------------------------------------------
Last Update Date | 02/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N95W18351 COUNTY LINE RD
-----------------------------------------------------
City | MENOMONEE FALLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53051-1335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-253-4705
-----------------------------------------------------
Fax | 262-253-4854
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N95 W18351 COUNTY LINE ROAD
-----------------------------------------------------
City | MENOMONEE FALLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-253-4705
-----------------------------------------------------
Fax | 262-253-4854
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 17176-40
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------