Provider Demographics
NPI:1548857188
Name:FETSKE, ZACHARY ALBERT
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ALBERT
Last Name:FETSKE
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 1:11 COURT HOUSE SOUTH DENNIS RD STE 9
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2150
Mailing Address - Country:US
Mailing Address - Phone:609-465-9010
Mailing Address - Fax:
Practice Address - Street 1:11 COURT HOUSE SOUTH DENNIS RD STE 9
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2150
Practice Address - Country:US
Practice Address - Phone:609-465-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04140600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist