Provider Demographics
NPI:1477534071
Name:RASA, PAUL R (RPH CCP)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:R
Last Name:RASA
Suffix:
Gender:M
Credentials:RPH CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4348 RUBERY DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-1148
Mailing Address - Country:US
Mailing Address - Phone:973-722-7272
Mailing Address - Fax:
Practice Address - Street 1:55 SKYLINE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-2037
Practice Address - Country:US
Practice Address - Phone:973-728-5800
Practice Address - Fax:973-728-7070
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01445600183500000X, 1835N1003X, 1835P1200X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric