Provider Demographics
NPI:1851779300
Name:RICH, GARY A
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:RICH
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 1:185 PROSPECT AVE
Mailing Address - Street 2:APT 6F
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2210
Mailing Address - Country:US
Mailing Address - Phone:201-981-4978
Mailing Address - Fax:201-880-5527
Practice Address - Street 1:185 PROSPECT AVE
Practice Address - Street 2:APT 6F
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2210
Practice Address - Country:US
Practice Address - Phone:201-981-4978
Practice Address - Fax:201-880-5527
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056793183500000X
NJ28RI01603900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist