MEDICARE: JENNA MARIE DEMY 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	26022918A	IN

General Provider Information

NPI Number	:	1437497484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA MARIE DEMY PHARMD.

Provider Business Mailing Address
First Line	:	13242 WICKER AVE
Second Line	:
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-9348
Country	:	US
Telephone Number	:	219-374-9346
Fax Number	:

Provider Business Practice Location Address
First Line	:	13242 WICKER AVE
Second Line	:
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-9348
Country	:	US
Telephone Number	:	219-374-9346
Fax Number	:

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

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	01/25/2013

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Directions to “ JENNA MARIE DEMY PHARMD.” Practice Location

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