Healthcare Provider Details

I. General information

NPI: 1538143870
Provider Name (Legal Business Name): JENNIFER MARIE ENGLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 A ST SE
AUBURN WA
98002-8610
US

IV. Provider business mailing address

1020 120TH ST S
TACOMA WA
98444-3710
US

V. Phone/Fax

Practice location:
  • Phone: 253-939-8563
  • Fax: 253-939-0869
Mailing address:
  • Phone: 253-576-3380
  • Fax: 253-939-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00044419
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: