MEDICARE: JACKY LIN

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	I069570	NY

General Provider Information

NPI Number	:	1487369021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKY LIN

Provider Business Mailing Address
First Line	:	3859 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-1540
Country	:	US
Telephone Number	:	212-928-7700
Fax Number	:	917-398-1308

Provider Business Practice Location Address
First Line	:	3859 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-1540
Country	:	US
Telephone Number	:	212-928-7700
Fax Number	:	917-398-1308

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

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	01/18/2023

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Directions to “ JACKY LIN ” Practice Location

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