MEDICARE: JOELLE JO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	28RI04224500	NJ

General Provider Information

NPI Number	:	1881352839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOELLE JO

Provider Business Mailing Address
First Line	:	5412 CITY PL
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-3171
Country	:	US
Telephone Number	:	732-425-2956
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 CEDAR LN
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-1713
Country	:	US
Telephone Number	:	201-347-3137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2021
Last Update Date	:	12/07/2021

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Directions to “ JOELLE JO ” Practice Location

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