Provider Demographics
NPI:1588012496
Name:MUSOKE, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MUSOKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 JACKSONVILLE JOBSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:JOBSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08041-2007
Mailing Address - Country:US
Mailing Address - Phone:609-510-1174
Mailing Address - Fax:
Practice Address - Street 1:412 SICKLERVILLE RD
Practice Address - Street 2:JOLIN'S PHARMACY #103
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081
Practice Address - Country:US
Practice Address - Phone:856-885-4510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02635200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist