Provider Demographics
NPI:1770825309
Name:ORLOVA, TATYANA N (RPH)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:N
Last Name:ORLOVA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 FORSGATE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1567
Mailing Address - Country:US
Mailing Address - Phone:732-641-2664
Mailing Address - Fax:732-641-2669
Practice Address - Street 1:333 FORSGATE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1567
Practice Address - Country:US
Practice Address - Phone:732-641-2664
Practice Address - Fax:732-641-2669
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03526800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist