Provider Demographics
NPI:1609106053
Name:XU, JIN JENNIFER (PHARMD)
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:JENNIFER
Last Name:XU
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 1:11216 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-4979
Mailing Address - Country:US
Mailing Address - Phone:425-355-9940
Mailing Address - Fax:425-355-8593
Practice Address - Street 1:11216 4TH AVE W
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-4979
Practice Address - Country:US
Practice Address - Phone:425-355-9940
Practice Address - Fax:425-355-8593
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00039250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist