Provider Demographics
NPI:1992087340
Name:JENCO, ROBERT S (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:JENCO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 ERCAMA ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-5726
Mailing Address - Country:US
Mailing Address - Phone:908-862-4699
Mailing Address - Fax:
Practice Address - Street 1:247 ROUTE 22 EAST
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-1807
Practice Address - Country:US
Practice Address - Phone:732-624-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03145800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist