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General NPI Number Information
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NPI Number | 1164798476
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Entity Type | Individual
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Provider Name | JENNIFER IN
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Gender | Female
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 9773 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1010
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Country | US
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Telephone | 215-673-0747
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Fax | 215-973-2050
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Provider Business Mailing Address
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Address Line | 9773 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1010
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Country | US
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Telephone | 215-673-0747
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Fax | 215-973-2050
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP439770
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License Number State | PA
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