MEDICARE: DR. JENNA SCOZZAFAVA 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	3206	WY

General Provider Information

NPI Number	:	1942952700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNA SCOZZAFAVA PHARMD

Provider Business Mailing Address
First Line	:	3131 E GRAND AVE UNIT B
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-5140
Country	:	US
Telephone Number	:	307-742-5048
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 E GRAND AVE UNIT B
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-5140
Country	:	US
Telephone Number	:	307-742-5048
Fax Number	:

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

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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