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General NPI Number Information
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NPI Number | 1376933135
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Entity Type | Individual
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Provider Name | LAURA JINKS
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Gender | Female
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 340 TOWNE DR
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-1371
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Country | US
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Telephone | 315-637-2876
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Fax |
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Provider Business Mailing Address
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Address Line | 104 DRISCOLL AVE
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City | SYRACUSE
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State | NY
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Zip | 13204-1534
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Country | US
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Telephone | 315-637-2876
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 10002657
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License Number State | NY
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