Basic Information
| Provider Information | |||||||||
| NPI: | 1992057681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AQUINO | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | GONZALEZ | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11697 LINDLY CT | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921313606 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2005 KNIGHT LANE ATTN: MEDICAL STAFF SERVICES BLDG H | ||||||||
| Address2: | NAVY MEDICINE SUPPORT COMMAND | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322120140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027623194 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2012 | ||||||||
| LastUpdateDate: | 10/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 63753 | CA | Y | Pharmacy Service Providers | Pharmacist | 183500000X | PS45744 | FL | N | Pharmacy Service Providers | Pharmacist |
No ID Information.