Healthcare Provider Details

I. General information

NPI: 1871375519
Provider Name (Legal Business Name): JENNIFER LEANN HULL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 GODWIN BLVD
SUFFOLK VA
23434-8037
US

IV. Provider business mailing address

2775 GODWIN BLVD
SUFFOLK VA
23434-8037
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-0069
  • Fax:
Mailing address:
  • Phone: 757-539-0069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202219028
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: