Provider Demographics
NPI:1366091308
Name:ANDERSON, JENNIFER (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MCARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01247-2146
Mailing Address - Country:US
Mailing Address - Phone:413-652-4178
Mailing Address - Fax:
Practice Address - Street 1:205 NORTH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1829
Practice Address - Country:US
Practice Address - Phone:802-442-5602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0082402183500000X
MAPH25450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist