Provider Demographics
NPI:1942661939
Name:HEADLEY, JOANNA M
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:HEADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DAY ST
Mailing Address - Street 2:APT. V11
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 DAY ST
Practice Address - Street 2:APT. V11
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2556
Practice Address - Country:US
Practice Address - Phone:973-713-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03733100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist