Provider Demographics
NPI:1760204283
Name:BRATTAIN, JENNIFER LEAH
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEAH
Last Name:BRATTAIN
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 1:3676 E STATE ROAD 234
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-7382
Mailing Address - Country:US
Mailing Address - Phone:317-468-8176
Mailing Address - Fax:
Practice Address - Street 1:3015 W US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-9280
Practice Address - Country:US
Practice Address - Phone:765-703-3035
Practice Address - Fax:765-221-7562
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017999A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist