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General NPI Number Information
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NPI Number | 1467053728
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Entity Type | Individual
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Provider Name | JENNA LOHR
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Gender | Female
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 30830 OLD US 20
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City | ELKHART
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State | IN
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Zip | 46514-9481
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Country | US
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Telephone | 574-674-5730
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Fax |
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Provider Business Mailing Address
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Address Line | 6420 SUMMER PLACE DR E APT 1B
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City | GRANGER
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State | IN
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Zip | 46530-8030
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Country | US
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Telephone | 419-410-6469
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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 | 03337960
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License Number State | OH
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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 | 26027794A
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License Number State | IN
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