Healthcare Provider Details

I. General information

NPI: 1366168783
Provider Name (Legal Business Name): JENNY KOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 PALM BEACH BLVD
FORT MYERS FL
33905-3637
US

IV. Provider business mailing address

4710 PALM BEACH BLVD
FORT MYERS FL
33905-3637
US

V. Phone/Fax

Practice location:
  • Phone: 239-694-7444
  • Fax:
Mailing address:
  • Phone: 239-694-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS64646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: