Provider Demographics
NPI:1679162952
Name:RICHARDS, JENNIFER NICOLE
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:PRESLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7010 W HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8300
Mailing Address - Country:US
Mailing Address - Phone:512-288-5713
Mailing Address - Fax:866-534-8654
Practice Address - Street 1:7010 W HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8300
Practice Address - Country:US
Practice Address - Phone:512-288-5713
Practice Address - Fax:866-534-8654
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141969183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician