Healthcare Provider Details

I. General information

NPI: 1285919571
Provider Name (Legal Business Name): JOLINS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 SICKLERVILLE RD STE 103
SICKLERVILLE NJ
08081-2557
US

IV. Provider business mailing address

412 SICKLERVILLE RD UNIT 103
SICKLERVILLE NJ
08081-2557
US

V. Phone/Fax

Practice location:
  • Phone: 856-885-4510
  • Fax: 856-885-4571
Mailing address:
  • Phone: 856-885-4510
  • Fax: 856-885-4571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00718300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN AGYEMANG
Title or Position: OWNER
Credential:
Phone: 856-885-4510