Healthcare Provider Details

I. General information

NPI: 1891021838
Provider Name (Legal Business Name): JENNIFER ROSE PRAGUE PHARM D, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 BROADWAY
NEW YORK NY
10025-2245
US

IV. Provider business mailing address

2833 BROADWAY
NEW YORK NY
10025-2245
US

V. Phone/Fax

Practice location:
  • Phone: 212-663-3135
  • Fax: 212-663-8153
Mailing address:
  • Phone: 212-663-3135
  • Fax: 212-663-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number053873
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: