MEDICARE: DR. JENIFER PANEK 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	19055	CO
2	183500000X	Pharmacist	051293486	IL
3	183500000X	Pharmacist	20055561	NY

General Provider Information

NPI Number	:	1750663506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENIFER PANEK PHARMD

Provider Business Mailing Address
First Line	:	309 US HIGHWAY 287
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8885
Country	:	US
Telephone Number	:	720-890-7041
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 US HIGHWAY 287
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8885
Country	:	US
Telephone Number	:	720-890-7041
Fax Number	:

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

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/16/2011

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