Provider Demographics
NPI:1881800381
Name:JIBI, JOSEPH KOCHADATHIL
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KOCHADATHIL
Last Name:JIBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 MASTER AVE
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6926
Mailing Address - Country:US
Mailing Address - Phone:615-335-2760
Mailing Address - Fax:
Practice Address - Street 1:8445 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136
Practice Address - Country:US
Practice Address - Phone:215-333-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist