MEDICARE: DR. JENNIFER CHU BROADWATER 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	62549	TX

General Provider Information

NPI Number	:	1528542990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER CHU BROADWATER PHARMD

Provider Business Mailing Address
First Line	:	1111 AUSTIN HWY APT 5406
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-4973
Country	:	US
Telephone Number	:	208-477-8446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 AUSTIN HWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-4854
Country	:	US
Telephone Number	:	210-202-3579
Fax Number	:	210-202-3589

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

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	09/20/2018

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