Provider Demographics
NPI:1639355696
Name:HOM-SPENCER, JENNIE (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:HOM-SPENCER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1207
Mailing Address - Country:US
Mailing Address - Phone:718-438-1207
Mailing Address - Fax:
Practice Address - Street 1:436 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4708
Practice Address - Country:US
Practice Address - Phone:718-833-7758
Practice Address - Fax:718-833-5095
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY42995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist