Provider Demographics
NPI:1699097998
Name:SISOLAK, JOSEPH JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JOHN
Last Name:SISOLAK
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 1:22 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1215
Mailing Address - Country:US
Mailing Address - Phone:201-823-9867
Mailing Address - Fax:
Practice Address - Street 1:121 ALGONQUIN PKWY
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1601
Practice Address - Country:US
Practice Address - Phone:973-503-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-28
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02659100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist