=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790049179
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER L SCHURMAN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2012
-----------------------------------------------------
Last Update Date | 02/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1230 7TH AVE
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98632-3166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-575-4850
-----------------------------------------------------
Fax | 360-636-6249
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41011 NE 12TH AVE
-----------------------------------------------------
City | WOODLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98674-3217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-225-9460
-----------------------------------------------------
Fax | 360-225-9460
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH00070250
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------