MEDICARE: JENNIFER LYNN POLANSKY 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	183500000X	Pharmacist	S011752	AZ

General Provider Information

NPI Number	:	1780914903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN POLANSKY PHARM.D.

Provider Business Mailing Address
First Line	:	5895 W PEORIA AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-1303
Country	:	US
Telephone Number	:	623-934-9152
Fax Number	:	623-934-9653

Provider Business Practice Location Address
First Line	:	5895 W PEORIA AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-1303
Country	:	US
Telephone Number	:	623-934-9152
Fax Number	:	623-934-9653

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

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	01/11/2010

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