Provider Demographics
NPI:1992467880
Name:ROUTH, ANTONIA R (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:R
Last Name:ROUTH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 EMERSON RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1681
Mailing Address - Country:US
Mailing Address - Phone:609-234-8903
Mailing Address - Fax:
Practice Address - Street 1:10 PLUM ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2066
Practice Address - Country:US
Practice Address - Phone:732-253-3699
Practice Address - Fax:732-253-3468
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RC000132001835P0018X
NJ28RI032424001835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist