Provider Demographics
NPI:1598378473
Name:INMAN, JACQULYNE (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:JACQULYNE
Middle Name:
Last Name:INMAN
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 SPRING ST STE 105
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1143
Mailing Address - Country:US
Mailing Address - Phone:201-380-7700
Mailing Address - Fax:646-934-6409
Practice Address - Street 1:41 SPRING ST STE 105
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1143
Practice Address - Country:US
Practice Address - Phone:201-380-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239376183500000X
NJ28RI04144800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist