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Individual

DR. ANKUR JETLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
397 ROUTE 46 W, FAIRFIELD, NJ 07004-1967
(973) 568-7830
Mailing address
397 ROUTE 46 W, FAIRFIELD, NJ 07004-1967
(973) 568-7830

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI02901900
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
28RI02901900
NEW JERSEY STATE PHARMACIST LICENSE NUMBER
NJ
Enumeration date
09/15/2011
Last updated
09/15/2011
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