Healthcare Provider Details

I. General information

NPI: 1538616875
Provider Name (Legal Business Name): NINA JIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2016
Last Update Date: 09/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 OXFORD AVE
PHILADELPHIA PA
19111-5400
US

IV. Provider business mailing address

7450 BROUS AVE
PHILADELPHIA PA
19152-4404
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-2557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP450898
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: