Provider Demographics
NPI:1912221409
Name:SAUERBORN, ROBERT EUGENE (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EUGENE
Last Name:SAUERBORN
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 1:4 THACKERAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1440
Mailing Address - Country:US
Mailing Address - Phone:201-513-6247
Mailing Address - Fax:
Practice Address - Street 1:4 THACKERAY DRIVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1440
Practice Address - Country:US
Practice Address - Phone:201-513-6247
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
NJ28R101395800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0211052Medicaid