Provider Demographics
NPI:1992984579
Name:COLUMBO, JODI LYNN
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:COLUMBO
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 1:283 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3667
Mailing Address - Country:US
Mailing Address - Phone:631-271-5856
Mailing Address - Fax:631-271-5127
Practice Address - Street 1:283 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3667
Practice Address - Country:US
Practice Address - Phone:631-271-5856
Practice Address - Fax:631-271-5127
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044701-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist