Provider Demographics
NPI:1821312398
Name:RICAURTE, ROBERT ERIC
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ERIC
Last Name:RICAURTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DEER RUN CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4005
Mailing Address - Country:US
Mailing Address - Phone:732-939-2277
Mailing Address - Fax:732-698-7207
Practice Address - Street 1:4041 HADLEY RD
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-1111
Practice Address - Country:US
Practice Address - Phone:908-222-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02604700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist