Healthcare Provider Details

I. General information

NPI: 1891858171
Provider Name (Legal Business Name): JENNIFER H DU PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5971 VENICE BLVD CARE MANAGEMENT DEPT
LOS ANGELES CA
90034-1713
US

IV. Provider business mailing address

PO BOX 1551
POMONA CA
91769-1551
US

V. Phone/Fax

Practice location:
  • Phone: 323-857-2110
  • Fax:
Mailing address:
  • Phone: 626-627-2939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number54998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: