Provider Demographics
NPI:1659665057
Name:SILVA, JENNIE MARIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:MARIE
Last Name:SILVA
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 1:121 CRUZ ORTIZ STELLA STREET DF 012849
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-285-0810
Mailing Address - Fax:787-285-2664
Practice Address - Street 1:121 CRUZ ORTIZ STELLA STREET DF 012849
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-285-0810
Practice Address - Fax:787-285-2664
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist