Provider Demographics
NPI:1134498421
Name:GULKO, RITA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:GULKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 POINT OF WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-2225
Mailing Address - Country:US
Mailing Address - Phone:732-591-1332
Mailing Address - Fax:
Practice Address - Street 1:153 POINT OF WOODS BLVD
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-2225
Practice Address - Country:US
Practice Address - Phone:732-591-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02996900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist