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NPI Code Detail

MEDICARE: JENNIFER PENG

MEDICARE: JENNIFER PENG
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
1183500000XPharmacistS016712AZ

General Provider Information

NPI Number : 1700111861
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER PENG
Provider Business Mailing Address
First Line : 4375 E IRMA LN
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4312
Country : US
Telephone Number : 480-890-5800
Fax Number :
Provider Business Practice Location Address
First Line : 4375 E IRMA LN
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4312
Country : US
Telephone Number : 480-890-5800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2009
Last Update Date : 10/30/2024

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