Provider Demographics
NPI:1972112860
Name:MA, JENNIFER KIM THU (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KIM THU
Last Name:MA
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 1:6430 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-9638
Mailing Address - Country:US
Mailing Address - Phone:281-420-3800
Mailing Address - Fax:
Practice Address - Street 1:6430 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-9638
Practice Address - Country:US
Practice Address - Phone:281-420-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist