Provider Demographics
NPI:1164855060
Name:KOWALCZYK, JACLYN ELYSE (PHARM D, RPH)
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:ELYSE
Last Name:KOWALCZYK
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2519
Mailing Address - Country:US
Mailing Address - Phone:732-462-5841
Mailing Address - Fax:
Practice Address - Street 1:425 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2519
Practice Address - Country:US
Practice Address - Phone:732-462-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03575800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist