Provider Demographics
NPI:1376866541
Name:CHAVEZ-PETROU, JENNIFER (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:CHAVEZ-PETROU
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 1:157-60 21 AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357
Mailing Address - Country:US
Mailing Address - Phone:516-672-4778
Mailing Address - Fax:
Practice Address - Street 1:777 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-1032
Practice Address - Country:US
Practice Address - Phone:516-433-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist