Provider Demographics
NPI:1073605531
Name:TRABULSI, TARA A (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:A
Last Name:TRABULSI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 HILL STREET
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432
Mailing Address - Country:US
Mailing Address - Phone:201-251-2102
Mailing Address - Fax:201-641-2939
Practice Address - Street 1:191 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643
Practice Address - Country:US
Practice Address - Phone:201-641-7200
Practice Address - Fax:201-641-2939
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03083100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6318606Medicaid