Provider Demographics
NPI:1184346959
Name:KALTENBACH, JACQUELINE AMANDA (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:AMANDA
Last Name:KALTENBACH
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ATLANTIC CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1223
Mailing Address - Country:US
Mailing Address - Phone:732-237-7142
Mailing Address - Fax:
Practice Address - Street 1:400 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1223
Practice Address - Country:US
Practice Address - Phone:732-237-7142
Practice Address - Fax:732-237-7148
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04271400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist