Provider Demographics
NPI:1003199902
Name:VENTOLA, ROY (RPH)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:VENTOLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 ROUTE 70
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4049
Mailing Address - Country:US
Mailing Address - Phone:732-262-6309
Mailing Address - Fax:732-262-6306
Practice Address - Street 1:465 ROUTE 70
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4049
Practice Address - Country:US
Practice Address - Phone:732-262-6309
Practice Address - Fax:732-262-6306
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01541700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist