Provider Demographics
NPI:1013384999
Name:HEO, JENNIFER YISU (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YISU
Last Name:HEO
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 1:20 JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2360
Mailing Address - Country:US
Mailing Address - Phone:732-846-9360
Mailing Address - Fax:
Practice Address - Street 1:20 JERSEY AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2360
Practice Address - Country:US
Practice Address - Phone:732-846-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03718100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist