Provider Demographics
NPI:1023643574
Name:BEEM, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BEEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 DURAND AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4402
Mailing Address - Country:US
Mailing Address - Phone:262-554-0035
Mailing Address - Fax:
Practice Address - Street 1:3915 DURAND AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:WI
Practice Address - Zip Code:53405-4402
Practice Address - Country:US
Practice Address - Phone:262-554-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19126-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist