Individual
DR. JACOB REVIRIEGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD, RPH
Contact information
Practice address
345 FRANKLIN AVE, BELLEVILLE, NJ 07109-1703
(973) 302-8703
Mailing address
87 BEAUMONT PL, NEWARK, NJ 07104-1701
(973) 484-9994
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI03581500
NJ
Other
Enumeration date
09/05/2013
Last updated
09/05/2013
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