Healthcare Provider Details

I. General information

NPI: 1144621046
Provider Name (Legal Business Name): JESSICA MONTEL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 JAMES ST
LAKEWOOD NJ
08701-4101
US

IV. Provider business mailing address

108 E ROUTE 130 S
BURLINGTON NJ
08016-2774
US

V. Phone/Fax

Practice location:
  • Phone: 732-719-4920
  • Fax: 732-719-4960
Mailing address:
  • Phone: 609-387-4998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03656300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: