Healthcare Provider Details

I. General information

NPI: 1104769546
Provider Name (Legal Business Name): JENNIFER CHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 HARTSEL DR
COLORADO SPRINGS CO
80920-4165
US

IV. Provider business mailing address

365 LIONSTONE DR APT A
COLORADO SPRINGS CO
80916-1184
US

V. Phone/Fax

Practice location:
  • Phone: 719-590-1099
  • Fax:
Mailing address:
  • Phone: 206-331-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0025464
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: