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General NPI Number Information
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NPI Number | 1053694612
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Entity Type | Individual
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Provider Name | JOHN HENRY PANKO
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Gender | Male
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 531 PROSPECT AVE
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1439
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Country | US
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Telephone | 732-219-7021
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Fax |
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Provider Business Mailing Address
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Address Line | 27 WATERS LN
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City | MILLSTONE TOWNSHIP
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State | NJ
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Zip | 08535-8170
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Country | US
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Telephone | 732-446-5758
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RI20661
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License Number State | NJ
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