Provider Demographics
NPI:1972273035
Name:VANDER, JENNIFER SHAYNA (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SHAYNA
Last Name:VANDER
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 1:2546 E 13TH ST APT D16
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4382
Mailing Address - Country:US
Mailing Address - Phone:917-405-0835
Mailing Address - Fax:
Practice Address - Street 1:2577 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4640
Practice Address - Country:US
Practice Address - Phone:718-258-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist