Provider Demographics
NPI:1922602663
Name:VENKATEWARAN, JILLIAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:VENKATEWARAN
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 1:184 S LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3014
Mailing Address - Country:US
Mailing Address - Phone:973-992-4720
Mailing Address - Fax:
Practice Address - Street 1:184 S LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3014
Practice Address - Country:US
Practice Address - Phone:973-992-4720
Practice Address - Fax:973-992-2851
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02942600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist