Provider Demographics
NPI:1457670945
Name:MEDON, JOSEPH J
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:MEDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 BAYER AVE
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-6648
Mailing Address - Country:US
Mailing Address - Phone:856-232-6461
Mailing Address - Fax:
Practice Address - Street 1:1410 LAUREL RD
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-3760
Practice Address - Country:US
Practice Address - Phone:856-346-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-23
Last Update Date:2010-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030166L183500000X
NJ28RI02518200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist