Provider Demographics
NPI:1003355033
Name:PURIFICACION, JENNIFER INGRID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:INGRID
Last Name:PURIFICACION
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 1:6431 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-4210
Mailing Address - Country:US
Mailing Address - Phone:619-988-5199
Mailing Address - Fax:
Practice Address - Street 1:640 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3213
Practice Address - Country:US
Practice Address - Phone:619-295-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist