Provider Demographics
NPI:1326654989
Name:CARUSO, THOMAS PETER JR (CPHT-ADV)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PETER
Last Name:CARUSO
Suffix:JR
Gender:M
Credentials:CPHT-ADV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1997
Mailing Address - Country:US
Mailing Address - Phone:551-996-2000
Mailing Address - Fax:
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:551-996-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW03649200183700000X, 3336S0011X, 183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
30122469OtherPTCB - ADVANCED CERTIFIED PHARMACY TECHNICIAN (CPHT-ADV)
30165265OtherPTCB - IMMUNIZATION ADMINISTRATION CERTIFICATE
NJ28RJ09897OtherIMMUNIZATION REGISTRATION
30182717OtherPTCB - CONTROLLED SUBSTANCES DIVERSION PREVENTION CERTIFICATE
30146731OtherPTCB - BILLING AND REIMBURSEMENT CERTIFICATE