MEDICARE: JENNIFER SUZANNE PRATHER PHARM D

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	1835G0303X	Geriatric Pharmacist	26021759A	IN

General Provider Information

NPI Number	:	1679748198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SUZANNE PRATHER PHARM D

Provider Business Mailing Address
First Line	:	675 PATRICK PL
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-2110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 PATRICK PL
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-2110
Country	:	US
Telephone Number	:	317-858-6600
Fax Number	:

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

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	04/25/2008

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