Provider Demographics
NPI:1538492350
Name:ROSELLE CENTER RITA PHARMACY
Entity Type:Organization
Organization Name:ROSELLE CENTER RITA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MALAV
Authorized Official - Middle Name:D
Authorized Official - Last Name:KANUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MPHARM
Authorized Official - Phone:732-668-2835
Mailing Address - Street 1:200 CHESTNUT ST
Mailing Address - Street 2:P.O.BOX 167
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-2263
Mailing Address - Country:US
Mailing Address - Phone:732-668-2835
Mailing Address - Fax:
Practice Address - Street 1:570 RARITAN RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2446
Practice Address - Country:US
Practice Address - Phone:908-245-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy