Provider Demographics
NPI:1366914640
Name:KRIVONAK, JENNIFER (PHARMD, RPH,MSPS,BS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:KRIVONAK
Suffix:
Gender:F
Credentials:PHARMD, RPH,MSPS,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10275 S RED OAK
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3382
Mailing Address - Country:US
Mailing Address - Phone:330-559-9494
Mailing Address - Fax:
Practice Address - Street 1:3402 CLARK AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1136
Practice Address - Country:US
Practice Address - Phone:216-961-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03331264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist