MEDICARE: JENNIFER PANTHER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	126051	MN
2	183500000X	Pharmacist	PS44413	FL
3	183500000X	Pharmacist	51.288757	IL
4	183500000X	Pharmacist	2008012999	MO
5	183500000X	Pharmacist	17856	NE
6	183500000X	Pharmacist	22463-40	WI
7	183500000X	Pharmacist	19514	IA

General Provider Information

NPI Number	:	1073345286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PANTHER PHARMD

Provider Business Mailing Address
First Line	:	6413 FOREST RD
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-3534
Country	:	US
Telephone Number	:	563-505-6449
Fax Number	:

Provider Business Practice Location Address
First Line	:	11739 W BRADLEY RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-2531
Country	:	US
Telephone Number	:	563-505-6449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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