Provider Demographics
NPI:1760149942
Name:JAIME, RICHARD ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROBERT
Last Name:JAIME
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 1:751 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4309
Mailing Address - Country:US
Mailing Address - Phone:973-481-2400
Mailing Address - Fax:973-481-1518
Practice Address - Street 1:751 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4309
Practice Address - Country:US
Practice Address - Phone:973-481-2400
Practice Address - Fax:973-481-1518
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02176000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist