Provider Demographics
NPI:1548589724
Name:RUSSOMANO, RICHARD G (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:G
Last Name:RUSSOMANO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 US HIGHWAY 22 E
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-3695
Mailing Address - Country:US
Mailing Address - Phone:908-534-0019
Mailing Address - Fax:908-534-1422
Practice Address - Street 1:531 US HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889-3695
Practice Address - Country:US
Practice Address - Phone:908-534-0019
Practice Address - Fax:908-534-1422
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01647400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist