Provider Demographics
NPI:1487306510
Name:NOVITSKY, JEREMY A (PHARMD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:A
Last Name:NOVITSKY
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 1:289 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2220
Mailing Address - Country:US
Mailing Address - Phone:201-664-1004
Mailing Address - Fax:201-263-1886
Practice Address - Street 1:289 BROADWAY
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2220
Practice Address - Country:US
Practice Address - Phone:201-664-1004
Practice Address - Fax:201-263-1886
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04111500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist