Provider Demographics
NPI:1477763555
Name:BORAD, RITA A
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:A
Last Name:BORAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4615
Mailing Address - Country:US
Mailing Address - Phone:732-626-0207
Mailing Address - Fax:
Practice Address - Street 1:104 ORLANDO DR
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-2124
Practice Address - Country:US
Practice Address - Phone:908-725-3001
Practice Address - Fax:732-725-3006
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02959700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist