Provider Demographics
NPI:1053745885
Name:DANG, JENNY (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:DANG
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 1:4411 KINSEY DR
Mailing Address - Street 2:APT 1136
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1015
Mailing Address - Country:US
Mailing Address - Phone:617-842-2151
Mailing Address - Fax:
Practice Address - Street 1:2201 256 LOOP
Practice Address - Street 2:APT 1136
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-1015
Practice Address - Country:US
Practice Address - Phone:617-842-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist