1639202625 NPI number — CMC DEPARTMENT OF MEDICINE

Table of content: MS. JENNIFER KAY HOMER RPH (NPI 1336402213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639202625 NPI number — CMC DEPARTMENT OF MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CMC DEPARTMENT OF MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639202625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 COOPER PLZ
Provider Second Line Business Mailing Address:
SUITE 502
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08103-1438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-342-2921
Provider Business Mailing Address Fax Number:
856-968-8499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1210 BRACE RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08034-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-428-6616
Provider Business Practice Location Address Fax Number:
856-428-4823
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCMULLEN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP MANAGED CARE
Authorized Official Telephone Number:
856-342-2921

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2621382000 . This is a "GASTRO GRP# FOR NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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