Provider Demographics
NPI:1154649184
Name:JOHN, LINJU JACOB (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:LINJU
Middle Name:JACOB
Last Name:JOHN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9280 KREWSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3723
Mailing Address - Country:US
Mailing Address - Phone:215-676-1453
Mailing Address - Fax:
Practice Address - Street 1:9280 KREWSTOWN RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3723
Practice Address - Country:US
Practice Address - Phone:215-676-1453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist