Provider Demographics
NPI:1699370791
Name:KASUKURTHI, RANJITA
Entity Type:Individual
Prefix:MS
First Name:RANJITA
Middle Name:
Last Name:KASUKURTHI
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 1:3211 NJ 27
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08810
Mailing Address - Country:US
Mailing Address - Phone:732-422-0213
Mailing Address - Fax:732-951-1270
Practice Address - Street 1:3211 NJ-27 SOUTH
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823
Practice Address - Country:US
Practice Address - Phone:732-422-0213
Practice Address - Fax:732-951-1270
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03090900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist