MEDICARE: DR. JENNIFER COLON 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	PCT.0015147	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730794272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER COLON PHARMD

Provider Business Mailing Address
First Line	:	26 IMLAY ST # 3
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-3608
Country	:	US
Telephone Number	:	310-210-0057
Fax Number	:

Provider Business Practice Location Address
First Line	:	789 HOWARD AVE
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06519-1300
Country	:	US
Telephone Number	:	888-461-0106
Fax Number	:

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

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	09/11/2020

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