Provider Demographics
NPI:1821341330
Name:CHOWDHURY, JENISA NUSRAT (CPHT)
Entity Type:Individual
Prefix:MISS
First Name:JENISA
Middle Name:NUSRAT
Last Name:CHOWDHURY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23768 NEWHALL AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-3125
Mailing Address - Country:US
Mailing Address - Phone:661-799-7017
Mailing Address - Fax:661-799-7021
Practice Address - Street 1:23768 NEWHALL AVE
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-3125
Practice Address - Country:US
Practice Address - Phone:661-799-7017
Practice Address - Fax:661-799-7021
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH 88359183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790082089OtherCROWN VALLEY PHARMACY NPI NUMBER