Provider Demographics
NPI:1114203544
Name:LE, JENNIFER S
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19661 HESPERIAN BLVD # T-2185
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4200
Mailing Address - Country:US
Mailing Address - Phone:510-731-0002
Mailing Address - Fax:
Practice Address - Street 1:19661 HESPERIAN BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4200
Practice Address - Country:US
Practice Address - Phone:510-731-0002
Practice Address - Fax:510-731-1422
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH27595183500000X
CA66883183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist