Provider Demographics
NPI:1952164394
Name:JOSEPH, JACOB ADITYANARAYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ADITYANARAYAN
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13146 HOOK CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1466
Mailing Address - Country:US
Mailing Address - Phone:646-705-2900
Mailing Address - Fax:
Practice Address - Street 1:9612 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1624
Practice Address - Country:US
Practice Address - Phone:718-480-6260
Practice Address - Fax:718-691-4917
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist