Provider Demographics
NPI:1710121496
Name:HSU, PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:HSU
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 1:421 BLOOMFIELD AVE
Mailing Address - Street 2:GUARDYS
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2497
Mailing Address - Country:US
Mailing Address - Phone:973-482-2648
Mailing Address - Fax:973-482-2649
Practice Address - Street 1:421 BLOOMFIELD AVE
Practice Address - Street 2:GUARDYS
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107
Practice Address - Country:US
Practice Address - Phone:973-482-2648
Practice Address - Fax:973-482-2649
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI17409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist