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General NPI Number Information
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NPI Number | 1598262529
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Entity Type | Individual
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Provider Name | JENNIFER MARI CORNFORTH PHARMD.
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Gender | Female
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 6257 MAJORCA CIR
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City | LONG BEACH
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State | CA
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Zip | 90803-4814
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Country | US
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Telephone | 386-212-2326
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Fax |
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Provider Business Mailing Address
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Address Line | 6257 MAJORCA CIR
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City | LONG BEACH
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State | CA
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Zip | 90803-4814
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Country | US
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Telephone | 386-212-2326
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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 | PS34997
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 78334
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License Number State | CA
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