Healthcare Provider Details

I. General information

NPI: 1528722535
Provider Name (Legal Business Name): JOHN SOBIESKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 S BROADWAY
PITMAN NJ
08071-1413
US

IV. Provider business mailing address

39 S BROADWAY
PITMAN NJ
08071-1413
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-2392
  • Fax:
Mailing address:
  • Phone: 856-589-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03036200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: