Provider Demographics
NPI:1982902714
Name:RAMDAT, JENA MICHELE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:MICHELE
Last Name:RAMDAT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:MICHELE
Other - Last Name:MARION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2615
Mailing Address - Country:US
Mailing Address - Phone:631-724-0381
Mailing Address - Fax:631-366-2688
Practice Address - Street 1:10 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2615
Practice Address - Country:US
Practice Address - Phone:631-724-0381
Practice Address - Fax:631-366-2688
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist