Healthcare Provider Details

I. General information

NPI: 1861585523
Provider Name (Legal Business Name): JENNIFER CHOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY
BERKELEY CA
94720-5642
US

IV. Provider business mailing address

PO BOX 718
BERKELEY CA
94701-0718
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-3249
  • Fax: 510-642-5759
Mailing address:
  • Phone: 510-684-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48743
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number48743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: