Individual
JEFFREY MICHAEL FENIMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
4526 W WESTERN AVE, SOUTH BEND, IN 46619-2302
(574) 288-0471
Mailing address
4526 W WESTERN AVE, SOUTH BEND, IN 46619-2302
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
2602798A
IN
Other
Enumeration date
03/24/2020
Last updated
03/24/2020
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