Provider Demographics
NPI:1003103946
Name:JODELKA, ERIK J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:J
Last Name:JODELKA
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 1:391 BEECROFT PL
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1227
Mailing Address - Country:US
Mailing Address - Phone:732-688-0297
Mailing Address - Fax:
Practice Address - Street 1:1915 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2771
Practice Address - Country:US
Practice Address - Phone:732-531-3784
Practice Address - Fax:732-531-7909
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02981000183500000X
NY055559-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist