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General NPI Number Information
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NPI Number | 1770038697
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Entity Type | Individual
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Provider Name | JACLYN TRIPPTREE PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 08/20/2016
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Last Update Date | 08/20/2016
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Provider Practice Location Address
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Address Line | 310 HILLSIDE AVE
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2525
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Country | US
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Telephone | 516-326-3506
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Fax |
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Provider Business Mailing Address
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Address Line | 64 PARKVIEW PL
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City | BALDWIN
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State | NY
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Zip | 11510-3737
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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 | 062161
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License Number State | NY
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