MEDICARE: JENNIFER ROSE BLACK

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	44141	TN

General Provider Information

NPI Number	:	1467079111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ROSE BLACK

Provider Business Mailing Address
First Line	:	4155 MAGNOLIA FARMS DR
Second Line	:
City	:	HERMITAGE
State	:	TN
Zip	:	37076-1638
Country	:	US
Telephone Number	:	615-294-2314
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 W MAIN ST
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-3186
Country	:	US
Telephone Number	:	615-444-3576
Fax Number	:

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

Provider Enumeration Date	:	06/29/2020
Last Update Date	:	09/11/2024

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Directions to “ JENNIFER ROSE BLACK ” Practice Location

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