Provider Demographics
NPI:1790378354
Name:MOLYNEAUX, JUAN J JR
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:MOLYNEAUX
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4920
Mailing Address - Country:US
Mailing Address - Phone:201-348-0810
Mailing Address - Fax:201-348-1555
Practice Address - Street 1:4012 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4920
Practice Address - Country:US
Practice Address - Phone:201-348-0810
Practice Address - Fax:201-348-1555
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03929300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist