Provider Demographics
NPI:1396357463
Name:DAGGUMATI, JAYARAM (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:JAYARAM
Middle Name:
Last Name:DAGGUMATI
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 STATE RT 23
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07416
Mailing Address - Country:US
Mailing Address - Phone:973-864-3202
Mailing Address - Fax:973-862-3203
Practice Address - Street 1:245 STATE RT 23
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NJ
Practice Address - Zip Code:07416
Practice Address - Country:US
Practice Address - Phone:973-864-3202
Practice Address - Fax:973-862-3203
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03995200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist