Provider Demographics
NPI:1841439809
Name:CHONG, JENNY W (RPH)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:W
Last Name:CHONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2606
Mailing Address - Country:US
Mailing Address - Phone:612-317-6500
Mailing Address - Fax:612-317-6525
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:SUITE 150
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2606
Practice Address - Country:US
Practice Address - Phone:612-317-6500
Practice Address - Fax:612-317-6525
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN116229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist