Provider Demographics
NPI:1619568953
Name:CHUNG, JENNIFER L (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CHUNG
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 1:131 BLUE RIBBON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-4257
Mailing Address - Country:US
Mailing Address - Phone:215-500-3225
Mailing Address - Fax:
Practice Address - Street 1:3400 CIVIC CENTER BLVD # 101W
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-6260
Practice Address - Fax:215-243-2345
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist