Provider Demographics
NPI:1871257873
Name:KWOK, JAMIE (PHARMD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:KWOK
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 1:543 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3601
Mailing Address - Country:US
Mailing Address - Phone:860-978-8170
Mailing Address - Fax:
Practice Address - Street 1:543 CLARK ST
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3601
Practice Address - Country:US
Practice Address - Phone:860-978-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066673183500000X
MAPH238994183500000X
CTPCT.0015477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist