Provider Demographics
NPI:1881964492
Name:STANTON, JESSICA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1490
Mailing Address - Country:US
Mailing Address - Phone:732-882-1057
Mailing Address - Fax:732-943-3784
Practice Address - Street 1:45 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1490
Practice Address - Country:US
Practice Address - Phone:732-882-1057
Practice Address - Fax:732-943-3784
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03380000183500000X
NY20 055048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist