Provider Demographics
NPI:1558630376
Name:VU, JENNIFER LY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LY
Last Name:VU
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 1:590 N HEATHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-2649
Mailing Address - Country:US
Mailing Address - Phone:714-890-1908
Mailing Address - Fax:
Practice Address - Street 1:590 N HEATHERSTONE DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-2649
Practice Address - Country:US
Practice Address - Phone:714-890-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist