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General NPI Number Information
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NPI Number | 1104124262
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Entity Type | Individual
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Provider Name | JEREMY LAIKEN
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Gender | Male
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Dates
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Enumeration Date | 03/14/2011
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 37 OLD HIGHWAY 22
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City | CLINTON
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State | NJ
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Zip | 08809-1342
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Country | US
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Telephone | 410-218-1419
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Fax |
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Provider Business Mailing Address
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Address Line | 217 PROSPECT AVE APT 12-2B
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City | CRANFORD
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State | NJ
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Zip | 07016-2256
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Country | US
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Telephone |
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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 | 28RI03357200
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License Number State | NJ
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