MEDICARE: JENNIFER HORTON 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	15770	OK

General Provider Information

NPI Number	:	1679169395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HORTON PHARMD

Provider Business Mailing Address
First Line	:	1231 N WASHINGTON AVE
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74701-2119
Country	:	US
Telephone Number	:	580-924-2903
Fax Number	:	580-924-7337

Provider Business Practice Location Address
First Line	:	1231 N WASHINGTON AVE
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74701-2119
Country	:	US
Telephone Number	:	580-924-2903
Fax Number	:	580-924-2903

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

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	12/16/2020

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