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General NPI Number Information
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NPI Number | 1346840253
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Entity Type | Individual
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Provider Name | JENNIFER CATHERINE DEAL
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Gender | Female
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 5303A WRIGHTSBORO RD
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City | GROVETOWN
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State | GA
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Zip | 30813-2800
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Country | US
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Telephone | 762-383-6527
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Fax |
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Provider Business Mailing Address
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Address Line | 2519 RAVENNA LN
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City | EVANS
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State | GA
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Zip | 30809-7097
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Country | US
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Telephone | 260-705-2949
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26018702A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 027130
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License Number State | GA
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