Healthcare Provider Details

I. General information

NPI: 1225721970
Provider Name (Legal Business Name): JENNIFER KWOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CLAY PIKE
NORTH HUNTINGDON PA
15642-2039
US

IV. Provider business mailing address

539 FARVIEW DR
GREENSBURG PA
15601-4642
US

V. Phone/Fax

Practice location:
  • Phone: 724-863-2350
  • Fax:
Mailing address:
  • Phone: 626-537-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP457386
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: