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General NPI Number Information
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NPI Number | 1326397589
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Entity Type | Individual
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Provider Name | JENNIFFER LEE
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Gender | Female
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 180 PASSAIC AVE
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City | FAIRFIELD
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State | NJ
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Zip | 07004-3516
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Country | US
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Telephone | 800-447-4791
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Fax |
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Provider Business Mailing Address
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Address Line | 31 LARCH ST
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City | CARTERET
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State | NJ
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Zip | 07008-2470
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Country | US
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Telephone |
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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 | 28RI03220700
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License Number State | NJ
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