Healthcare Provider Details

I. General information

NPI: 1942411129
Provider Name (Legal Business Name): JEFFREY ALAN SEPTIMUS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 BAKERTOWN RD
MONROE NY
10950-8428
US

IV. Provider business mailing address

15 BELMONT PL
PASSAIC NJ
07055-4501
US

V. Phone/Fax

Practice location:
  • Phone: 845-774-1464
  • Fax: 845-774-1454
Mailing address:
  • Phone: 973-471-8606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRI025961
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: