Provider Demographics
NPI:1376813816
Name:COUGLE, JENNIFER ALEXANDER (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALEXANDER
Last Name:COUGLE
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 1:360 HARDY ROAD
Mailing Address - Street 2:
Mailing Address - City:MISSISSIPPI STATE
Mailing Address - State:MS
Mailing Address - Zip Code:39762
Mailing Address - Country:US
Mailing Address - Phone:662-325-8205
Mailing Address - Fax:662-325-0000
Practice Address - Street 1:220 HIGHWAY 12 W
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3762
Practice Address - Country:US
Practice Address - Phone:662-325-8205
Practice Address - Fax:662-325-0000
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist