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General NPI Number Information
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NPI Number | 1477159259
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Entity Type | Individual
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Provider Name | JED BARTHOLOMEW PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 750 MEMORIAL PKWY
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-1679
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Country | US
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Telephone | 908-329-9026
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Fax |
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Provider Business Mailing Address
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Address Line | 112 PINE CT
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City | SAYLORSBURG
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State | PA
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Zip | 18353-8039
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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 | 28RI04142700
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License Number State | NJ
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