Provider Demographics
NPI:1679719538
Name:ALEXANDRE, JEPHTE
Entity type:Individual
Prefix:
First Name:JEPHTE
Middle Name:
Last Name:ALEXANDRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 SANDFORD AVE # 854
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3674
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 PEACHTREE RD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-1931
Practice Address - Country:US
Practice Address - Phone:862-371-2569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-25
Last Update Date:2008-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03015800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist