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General NPI Number Information
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NPI Number | 1255963716
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Entity Type | Individual
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Provider Name | JESSICA LYNN PU
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Gender | Female
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 3333 CLARK ST
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City | ALAMOSA
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State | CO
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Zip | 81101-2050
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Country | US
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Telephone | 719-589-9021
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Fax |
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Provider Business Mailing Address
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Address Line | 4527 NW 36TH TER
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City | GAINESVILLE
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State | FL
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Zip | 32605-5421
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Country | US
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Telephone | 352-872-8458
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Fax |
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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 | PHA0022566
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License Number State | CO
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