MEDICARE: MARQUESA C JACKSON-LOCKLEAR RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	28RI02273100	NJ

General Provider Information

NPI Number	:	1316115124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUESA C JACKSON-LOCKLEAR RPH

Provider Business Mailing Address
First Line	:	4578 ROUTE 9 S
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-3771
Country	:	US
Telephone Number	:	732-364-3700
Fax Number	:	731-901-6582

Provider Business Practice Location Address
First Line	:	4578 ROUTE 9 S
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-3771
Country	:	US
Telephone Number	:	732-364-3700
Fax Number	:	731-901-6582

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/14/2008

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