MEDICARE: JACQULYNE INMAN RPH, PHARMD

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	PH239376	MA
2	183500000X	Pharmacist	28RI04144800	NJ

General Provider Information

NPI Number	:	1598378473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQULYNE INMAN RPH, PHARMD

Provider Business Mailing Address
First Line	:	41 SPRING ST STE 105
Second Line	:
City	:	NEW PROVIDENCE
State	:	NJ
Zip	:	07974-1143
Country	:	US
Telephone Number	:	201-380-7700
Fax Number	:	646-934-6409

Provider Business Practice Location Address
First Line	:	41 SPRING ST STE 105
Second Line	:
City	:	NEW PROVIDENCE
State	:	NJ
Zip	:	07974-1143
Country	:	US
Telephone Number	:	201-380-7700
Fax Number	:

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

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	04/01/2021

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