Provider Demographics
NPI:1003124488
Name:NGUYEN, JENNIFER L (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W OXFORD ST
Mailing Address - Street 2:APT W124
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-3927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 E WYOMING AVE
Practice Address - Street 2:PHARMACY & NUTRITION SHOPPE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3808
Practice Address - Country:US
Practice Address - Phone:215-537-7626
Practice Address - Fax:215-737-7987
Is Sole Proprietor?:No
Enumeration Date:2010-09-19
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18519183500000X
PARP-045393-L183500000X
DEA1-0003126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist