Healthcare Provider Details

I. General information

NPI: 1275284929
Provider Name (Legal Business Name): JEVIN TZENG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16375 WASHINGTON ST
THORNTON CO
80023-8907
US

IV. Provider business mailing address

898 S KALISPELL CIR UNIT 102
AURORA CO
80017-2080
US

V. Phone/Fax

Practice location:
  • Phone: 303-474-3254
  • Fax:
Mailing address:
  • Phone: 501-339-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0023689
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: