Healthcare Provider Details

I. General information

NPI: 1689956492
Provider Name (Legal Business Name): JENNIFER MONICA RYU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 E COLORADO BLVD
PASADENA CA
91107-4249
US

IV. Provider business mailing address

2376 E COLORADO BLVD
PASADENA CA
91107-4249
US

V. Phone/Fax

Practice location:
  • Phone: 626-768-4040
  • Fax: 626-768-4046
Mailing address:
  • Phone: 626-768-4040
  • Fax: 626-768-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: