Provider Demographics
NPI:1265451413
Name:INCOGNITO, HANK (RPH)
Entity Type:Individual
Prefix:
First Name:HANK
Middle Name:
Last Name:INCOGNITO
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 1:994 RAHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1946
Mailing Address - Country:US
Mailing Address - Phone:732-634-1914
Mailing Address - Fax:732-634-5708
Practice Address - Street 1:994 RAHWAY AVE
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1946
Practice Address - Country:US
Practice Address - Phone:732-634-1914
Practice Address - Fax:732-634-5708
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI27264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist