Healthcare Provider Details

I. General information

NPI: 1417679291
Provider Name (Legal Business Name): JENNIFER DAO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 01/29/2023
Certification Date: 01/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E 2ND ST
POMONA CA
91766-1854
US

IV. Provider business mailing address

309 E 2ND ST
POMONA CA
91766-1854
US

V. Phone/Fax

Practice location:
  • Phone: 909-469-5274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: