Healthcare Provider Details

I. General information

NPI: 1881386035
Provider Name (Legal Business Name): JENNIE JOHN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WESTCHESTER AVE
WEST HARRISON NY
10604-3200
US

IV. Provider business mailing address

166 MADISON AVE
VALHALLA NY
10595-1833
US

V. Phone/Fax

Practice location:
  • Phone: 914-367-7015
  • Fax:
Mailing address:
  • Phone: 914-417-1246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number061296
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: