Provider Demographics
NPI:1285919571
Name:JOLINS PHARMACY
Entity type:Organization
Organization Name:JOLINS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGYEMANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-885-4510
Mailing Address - Street 1:412 SICKLERVILLE RD
Mailing Address - Street 2:UNIT 103
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-2557
Mailing Address - Country:US
Mailing Address - Phone:856-885-4510
Mailing Address - Fax:856-885-4571
Practice Address - Street 1:412 SICKLERVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-2557
Practice Address - Country:US
Practice Address - Phone:856-885-4510
Practice Address - Fax:856-885-4571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NJ28RS007183003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134259OtherPK