MEDICARE: JENNIFER TAN

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	054251	NY

General Provider Information

NPI Number	:	1528383650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER TAN

Provider Business Mailing Address
First Line	:	428 48TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1919
Country	:	US
Telephone Number	:	718-541-2454
Fax Number	:

Provider Business Practice Location Address
First Line	:	428 48TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1919
Country	:	US
Telephone Number	:	718-541-2454
Fax Number	:

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

Provider Enumeration Date	:	03/31/2010
Last Update Date	:	03/31/2010

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Directions to “ JENNIFER TAN ” Practice Location

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