Provider Demographics
NPI:1144595166
Name:O'ROURKE, COLLEEN ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ANN
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3409
Mailing Address - Country:US
Mailing Address - Phone:973-625-4505
Mailing Address - Fax:
Practice Address - Street 1:75 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:NETCONG
Practice Address - State:NJ
Practice Address - Zip Code:07857-1400
Practice Address - Country:US
Practice Address - Phone:973-347-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02213100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist