Provider Demographics
NPI:1578726774
Name:STOCKETT, GLEN EVAN (DVM)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:EVAN
Last Name:STOCKETT
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 ATLANTIC AVE
Mailing Address - Street 2:P.O. BOX 183
Mailing Address - City:ALLENWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08720-7006
Mailing Address - Country:US
Mailing Address - Phone:732-528-7444
Mailing Address - Fax:732-528-5637
Practice Address - Street 1:3002 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ALLENWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08720-7006
Practice Address - Country:US
Practice Address - Phone:732-528-7444
Practice Address - Fax:732-528-5637
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29VI00427900174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian