Provider Demographics
NPI:1316539422
Name:NASRALLA, ROBIL
Entity Type:Individual
Prefix:
First Name:ROBIL
Middle Name:
Last Name:NASRALLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 MILLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3321
Mailing Address - Country:US
Mailing Address - Phone:732-247-2333
Mailing Address - Fax:
Practice Address - Street 1:569 MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3321
Practice Address - Country:US
Practice Address - Phone:732-247-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04010600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist