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General NPI Number Information
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NPI Number | 1861124513
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Entity Type | Individual
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Provider Name | JENNA NICOLE LEE PHARMD, BCPS
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Gender | Female
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 3300 MAIN ST STE 3A
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City | SPRINGFIELD
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State | MA
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Zip | 01199-1271
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Country | US
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Telephone | 413-794-7493
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Fax |
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Provider Business Mailing Address
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Address Line | 1119 CANYON RIDGE DR
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City | BROAD BROOK
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State | CT
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Zip | 06016-5609
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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 | PH239099
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License Number State | MA
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