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General NPI Number Information
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NPI Number | 1689799892
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Entity Type | Individual
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Provider Name | JOSE DEVASSY PULLOCKARAN R.PH.,PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 249 UNIVERSITY AVE ROOM 104
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City | NEWARK
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State | NJ
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Zip | 07102-1808
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Country | US
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Telephone | 973-353-5201
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Fax |
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Provider Business Mailing Address
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Address Line | 195 SHREWSBURY CT
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City | PENNINGTON
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State | NJ
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Zip | 08534-5418
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Country | US
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Telephone | 609-737-2274
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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 | 28RI02492300
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License Number State | NJ
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