Provider Demographics
NPI:1306163712
Name:KOLO, JEFFREY DAVID (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:KOLO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SUSSEX LN
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-5105
Mailing Address - Country:US
Mailing Address - Phone:609-448-6769
Mailing Address - Fax:609-448-6769
Practice Address - Street 1:191 DUTCH NECK RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2716
Practice Address - Country:US
Practice Address - Phone:609-448-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044194L183500000X
NJ28RI02631100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist