Provider Demographics
NPI:1316591480
Name:CHEN, JIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JIE
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:JACKY
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:11 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-2347
Mailing Address - Country:US
Mailing Address - Phone:917-903-1917
Mailing Address - Fax:
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-907-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0011678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist