Provider Demographics
NPI:1932527439
Name:CHIU, JENNY W
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:W
Last Name:CHIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 SW CAMPUS DR
Mailing Address - Street 2:APT 39-B2
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-5056
Mailing Address - Country:US
Mailing Address - Phone:857-499-0507
Mailing Address - Fax:
Practice Address - Street 1:9505 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2801
Practice Address - Country:US
Practice Address - Phone:253-582-2230
Practice Address - Fax:253-582-0654
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60349465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH234309OtherPHARMACIST LICENSE
WAPH60349465OtherPHARMACIST LICENSE