Individual
JENNIFER AJIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
192 N MAIN ST, FOND DU LAC, WI 54935-3462
(920) 921-5264
Mailing address
192 N MAIN ST, FOND DU LAC, WI 54935-3462
(920) 921-5264
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
05100007
IL
183500000X
Pharmacist
Primary
1872840
WI
Other
Enumeration date
02/22/2020
Last updated
02/22/2020
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