=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598092108
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENENAH A FOLLER RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2009
-----------------------------------------------------
Last Update Date | 11/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5941 E MCKELLIPS RD
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85215-2754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-830-6343
-----------------------------------------------------
Fax | 480-981-0156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 N PEPPERTREE DR
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85234-4920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-227-1880
-----------------------------------------------------
Fax | 480-981-0156
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | S13522
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------