Provider Demographics
NPI:1417793647
Name:XIE, JENNIE ELIZABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:ELIZABETH
Last Name:XIE
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 1:14 WIGGLESWORTH ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-7422
Mailing Address - Country:US
Mailing Address - Phone:401-527-2882
Mailing Address - Fax:
Practice Address - Street 1:103 UNION ST
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2201
Practice Address - Country:US
Practice Address - Phone:617-928-8455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP00136698183500000X
MAPH241136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist