Individual
JENNIFER WYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
905 W MAIN ST, BOONVILLE, IN 47601-1567
(812) 897-8828
Mailing address
905 W MAIN ST, BOONVILLE, IN 47601-1567
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26022408A
IN
Other
Enumeration date
12/06/2020
Last updated
12/06/2020
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