Provider Demographics
NPI:1588085161
Name:CHU, JENNIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:
Last Name:CHU
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 1:933 W ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2420
Mailing Address - Country:US
Mailing Address - Phone:909-592-5361
Mailing Address - Fax:
Practice Address - Street 1:933 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2420
Practice Address - Country:US
Practice Address - Phone:909-592-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist