Provider Demographics
NPI:1942411129
Name:SEPTIMUS, JEFFREY ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:SEPTIMUS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BELMONT PL
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4501
Mailing Address - Country:US
Mailing Address - Phone:973-471-8606
Mailing Address - Fax:
Practice Address - Street 1:48 BAKERTOWN RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-8428
Practice Address - Country:US
Practice Address - Phone:845-774-1464
Practice Address - Fax:845-774-1454
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI025961183500000X
NY046314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist