Provider Demographics
NPI:1902001365
Name:COTILUS, ERNEST III (RPH)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:COTILUS
Suffix:III
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 1:26 ARBOUR LN
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 CRESCENT DR FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1016
Practice Address - Country:US
Practice Address - Phone:215-890-2000
Practice Address - Fax:215-890-9935
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2019-05-08
Deactivation Date:2014-07-21
Deactivation Code:
Reactivation Date:2019-05-08
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02911300183500000X
PARP042149L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist