Healthcare Provider Details

I. General information

NPI: 1558957019
Provider Name (Legal Business Name): JOHN POWER PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 LAKEHURST RD
BROWNS MILLS NJ
08015-6060
US

IV. Provider business mailing address

558 LAKEHURST RD
BROWNS MILLS NJ
08015-6060
US

V. Phone/Fax

Practice location:
  • Phone: 609-893-4700
  • Fax:
Mailing address:
  • Phone: 609-893-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01537900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: