Provider Demographics
NPI:1225616832
Name:GAWRGUS, THOMAS REDA (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:REDA
Last Name:GAWRGUS
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 1:455 W SIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1425
Mailing Address - Country:US
Mailing Address - Phone:201-360-3233
Mailing Address - Fax:201-360-3361
Practice Address - Street 1:455 W SIDE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1425
Practice Address - Country:US
Practice Address - Phone:201-360-3233
Practice Address - Fax:201-360-3361
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI035630001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist