Provider Demographics
NPI:1023529781
Name:EKMEKJI, JENNY ANOUSH (RPH)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:ANOUSH
Last Name:EKMEKJI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:ANOUSH
Other - Last Name:BALABANIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 TENNESSEE ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3421
Mailing Address - Country:US
Mailing Address - Phone:800-874-5881
Mailing Address - Fax:
Practice Address - Street 1:1400 TENNESSEE ST UNIT 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-3421
Practice Address - Country:US
Practice Address - Phone:800-874-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76542183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist