MEDICARE: SOPHIA JEN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	068410I	NY

General Provider Information

NPI Number	:	1215692900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA JEN PHARMD

Provider Business Mailing Address
First Line	:	3527 201ST ST
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-1113
Country	:	US
Telephone Number	:	347-420-8123
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 MERRICK RD
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-4703
Country	:	US
Telephone Number	:	516-684-9732
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2021
Last Update Date	:	11/08/2021

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Directions to “ SOPHIA JEN PHARMD” Practice Location

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