Provider Demographics
NPI:1801103676
Name:HUTKIN, JERROLD D (RPH)
Entity type:Individual
Prefix:
First Name:JERROLD
Middle Name:D
Last Name:HUTKIN
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 1:249 CUTHBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1017
Mailing Address - Country:US
Mailing Address - Phone:856-869-5410
Mailing Address - Fax:
Practice Address - Street 1:249 CUTHBERT BLVD
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08107-1017
Practice Address - Country:US
Practice Address - Phone:856-869-5410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RJ01400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist