Provider Demographics
NPI:1184998148
Name:AHN, JENNIFER YOUNG (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YOUNG
Last Name:AHN
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 1:12350 CARMEL MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4616
Mailing Address - Country:US
Mailing Address - Phone:858-675-0930
Mailing Address - Fax:858-675-0932
Practice Address - Street 1:12350 CARMEL MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4616
Practice Address - Country:US
Practice Address - Phone:858-675-0930
Practice Address - Fax:858-675-0932
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist