MEDICARE: JENNIFER PROPHITT

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	RPH034719	GA

General Provider Information

NPI Number	:	1497507560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PROPHITT

Provider Business Mailing Address
First Line	:	928 OAKWOOD DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-2482
Country	:	US
Telephone Number	:	706-617-4807
Fax Number	:

Provider Business Practice Location Address
First Line	:	1591 BRADLEY PARK DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3071
Country	:	US
Telephone Number	:	706-327-8201
Fax Number	:

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

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/03/2024

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Directions to “ JENNIFER PROPHITT ” Practice Location

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