1073758330 NPI number — DR. JENNIFER LYNN KOLESAR PHARM.D.

Table of content: DR. JENNIFER LYNN KOLESAR PHARM.D. (NPI 1073758330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073758330 NPI number — DR. JENNIFER LYNN KOLESAR PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLESAR
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073758330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CVS PHARMACY 68 MAIN ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BINGHAMTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-773-8338
Provider Business Mailing Address Fax Number:
607-773-1649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CVS PHARMACY 68 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BINGHAMTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-773-8338
Provider Business Practice Location Address Fax Number:
607-773-1649
Provider Enumeration Date:
12/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  047600 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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