Provider Demographics
NPI:1245552686
Name:WEXLER, JEROME M (RPH)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:M
Last Name:WEXLER
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 1:682 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1238
Mailing Address - Country:US
Mailing Address - Phone:631-246-8735
Mailing Address - Fax:631-246-8736
Practice Address - Street 1:682 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1238
Practice Address - Country:US
Practice Address - Phone:631-246-8735
Practice Address - Fax:631-246-8736
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist