Healthcare Provider Details

I. General information

NPI: 1780490458
Provider Name (Legal Business Name): JENNY HA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BERGER RD
PADUCAH KY
42003-4522
US

IV. Provider business mailing address

230 BERGER RD
PADUCAH KY
42003-4522
US

V. Phone/Fax

Practice location:
  • Phone: 270-442-9527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number024605
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1835N0905X
TaxonomyNuclear Pharmacist
License Number024605
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: