Provider Demographics
NPI:1528284114
Name:JESUELE, JOSEPH JR (RPH)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:JESUELE
Suffix:JR
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 WOODYFIELD LN
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1884
Mailing Address - Country:US
Mailing Address - Phone:215-205-5210
Mailing Address - Fax:
Practice Address - Street 1:88 HARTFORD ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-1884
Practice Address - Country:US
Practice Address - Phone:215-205-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02524100183500000X
PARP042441L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist