Provider Demographics
NPI:1649549585
Name:GRODMAN, JOEL R (RPH)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:R
Last Name:GRODMAN
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 1:114 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1723
Mailing Address - Country:US
Mailing Address - Phone:973-344-9000
Mailing Address - Fax:973-589-2468
Practice Address - Street 1:114 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1723
Practice Address - Country:US
Practice Address - Phone:973-344-9000
Practice Address - Fax:973-589-2468
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01316900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist