Individual
BRANDON RICHARD HETZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1163 E CHESTNUT AVE, VINELAND, NJ 08360-5001
(856) 205-7371
Mailing address
69 RANDOLPH RD, BRIDGETON, NJ 08302-3845
(609) 501-9776
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI03668300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012220
—
NJ
Enumeration date
12/01/2020
Last updated
12/01/2020
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