Provider Demographics
NPI:1134387301
Name:CRISFULLA, CATHERINE MARY (RPH)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARY
Last Name:CRISFULLA
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 1:11 SURREY PL
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1400
Mailing Address - Country:US
Mailing Address - Phone:856-241-1663
Mailing Address - Fax:
Practice Address - Street 1:130 WHITE HORSE PIKE N
Practice Address - Street 2:
Practice Address - City:LAWNSIDE
Practice Address - State:NJ
Practice Address - Zip Code:08045-1128
Practice Address - Country:US
Practice Address - Phone:856-546-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002854183500000X
NJ28RI02299700183500000X
PARP038114L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A1-0002854OtherDELAWARE STATE LICENSE NUMBER
RP038114LOtherPENNSYLVANIA STATE LICENSE NUMBER
28RI02299700OtherNJ STATE LICENSE NUMBER