Provider Demographics
NPI:1689997983
Name:KAALE-SENELORM, LOVENESS JACOB (PHARMD)
Entity Type:Individual
Prefix:
First Name:LOVENESS
Middle Name:JACOB
Last Name:KAALE-SENELORM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 METROPOLITAN OVAL APT 5D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6791
Mailing Address - Country:US
Mailing Address - Phone:973-752-8272
Mailing Address - Fax:
Practice Address - Street 1:78 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4466
Practice Address - Country:US
Practice Address - Phone:973-778-0971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03247700183500000X
NY054350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist