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Individual

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Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
301 N HARRISON ST, PRINCETON, NJ 08540-3512
(609) 924-6125
Mailing address
6 ANTHONY LN, LAWRENCEVILLE, NJ 08648-2824

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI03789700
NJ

Other

Enumeration date
07/27/2016
Last updated
07/27/2016
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