Healthcare Provider Details

I. General information

NPI: 1396357463
Provider Name (Legal Business Name): JAYARAM DAGGUMATI DOCTOR OF PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 STATE RT 23
FRANKLIN NJ
07416
US

IV. Provider business mailing address

245 STATE RT 23
FRANKLIN NJ
07416
US

V. Phone/Fax

Practice location:
  • Phone: 973-864-3202
  • Fax: 973-862-3203
Mailing address:
  • Phone: 973-864-3202
  • Fax: 973-862-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03995200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: