Healthcare Provider Details

I. General information

NPI: 1891395075
Provider Name (Legal Business Name): JEN-WEN HSU-YIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 FAIRHAVEN COMMONS WAY
FAIRHAVEN MA
02719-4627
US

IV. Provider business mailing address

PO BOX 846
FAIRHAVEN MA
02719-0800
US

V. Phone/Fax

Practice location:
  • Phone: 508-993-4250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH24329
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: