Healthcare Provider Details

I. General information

NPI: 1750978219
Provider Name (Legal Business Name): JASMINE CHOI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WHITE ST
CAMBRIDGE MA
02140
US

IV. Provider business mailing address

36 WHITE ST
CAMBRIDGE MA
02140
US

V. Phone/Fax

Practice location:
  • Phone: 617-876-5519
  • Fax:
Mailing address:
  • Phone: 617-876-5519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH234948
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: