Provider Demographics
NPI:1366253940
Name:PINK, JENNIFER JANE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANE
Last Name:PINK
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 1:5612 AMNEST WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1928
Mailing Address - Country:US
Mailing Address - Phone:916-243-8422
Mailing Address - Fax:
Practice Address - Street 1:1214 N MARKET BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2931
Practice Address - Country:US
Practice Address - Phone:800-655-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist