Provider Demographics
NPI:1295018786
Name:LEBAK, JENNIFER KAI-MING (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:KAI-MING
Last Name:LEBAK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 STARBOARD WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-6115
Mailing Address - Country:US
Mailing Address - Phone:973-876-2402
Mailing Address - Fax:
Practice Address - Street 1:4296 ROUTE 130
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-2027
Practice Address - Country:US
Practice Address - Phone:609-871-9017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03373400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist