Provider Demographics
NPI:1598525115
Name:JACKSON VILLAGE PHARMACY LLC
Entity Type:Organization
Organization Name:JACKSON VILLAGE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OUELLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-994-7387
Mailing Address - Street 1:27 S COOKS BRIDGE RD STE 1-1
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2460
Mailing Address - Country:US
Mailing Address - Phone:732-994-7387
Mailing Address - Fax:
Practice Address - Street 1:27 S COOKS BRIDGE RD STE 1-1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2460
Practice Address - Country:US
Practice Address - Phone:732-994-7387
Practice Address - Fax:732-994-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy