Provider Demographics
NPI:1952681553
Name:MARIETTA, RUTH (RPH)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:MARIETTA
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 1:375 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-1359
Mailing Address - Country:US
Mailing Address - Phone:732-832-7041
Mailing Address - Fax:732-832-7043
Practice Address - Street 1:375 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:PORT MONMOUTH
Practice Address - State:NJ
Practice Address - Zip Code:07758-1359
Practice Address - Country:US
Practice Address - Phone:732-832-7041
Practice Address - Fax:732-832-7043
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01991000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist