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NPI Code Detail

MEDICARE: JENNY TRI PHARM. D

MEDICARE: JENNY TRI PHARM. D
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
1183500000XPharmacist55229CA

General Provider Information

NPI Number : 1306139571
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNY TRI PHARM. D
Provider Business Mailing Address
First Line : 3121 E COLORADO BLVD
Second Line : TARGET PHARMACY
City : PASADENA
State : CA
Zip : 91107-3814
Country : US
Telephone Number : 626-584-2963
Fax Number : 626-584-2963
Provider Business Practice Location Address
First Line : 3121 E COLORADO BLVD
Second Line : TARGET PHARMACY
City : PASADENA
State : CA
Zip : 91107-3814
Country : US
Telephone Number : 626-584-2963
Fax Number : 626-584-2963
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2011
Last Update Date : 05/22/2011

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