Provider Demographics
NPI:1265029359
Name:TOOTELL, EDWARD JR (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:TOOTELL
Suffix:JR
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 1:23202 COLUMBUS RD STE E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1982
Mailing Address - Country:US
Mailing Address - Phone:609-298-7474
Mailing Address - Fax:609-298-6811
Practice Address - Street 1:23202 COLUMBUS RD STE E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1982
Practice Address - Country:US
Practice Address - Phone:609-298-7474
Practice Address - Fax:609-298-6811
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI16058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist