Provider Demographics
NPI:1679321822
Name:DANT, JENNA NICOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:NICOLE
Last Name:DANT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6N999 BRISTOL CT
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6399
Mailing Address - Country:US
Mailing Address - Phone:260-249-0545
Mailing Address - Fax:
Practice Address - Street 1:815 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-3003
Practice Address - Country:US
Practice Address - Phone:847-717-6510
Practice Address - Fax:847-717-6565
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051306275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist