Healthcare Provider Details

I. General information

NPI: 1730794272
Provider Name (Legal Business Name): JENNIFER COLON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 HOWARD AVE
NEW HAVEN CT
06519-1300
US

IV. Provider business mailing address

26 IMLAY ST # 3
HARTFORD CT
06105-3608
US

V. Phone/Fax

Practice location:
  • Phone: 888-461-0106
  • Fax:
Mailing address:
  • Phone: 310-210-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0015147
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: