Provider Demographics
NPI:1205495322
Name:ROUTH, SUGITI N/A (RPH)
Entity type:Individual
Prefix:
First Name:SUGITI
Middle Name:N/A
Last Name:ROUTH
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 1:1943 ZION RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1523
Mailing Address - Country:US
Mailing Address - Phone:609-334-3381
Mailing Address - Fax:
Practice Address - Street 1:609 BERLIN CROSS KEYS RD STE D1
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-9535
Practice Address - Country:US
Practice Address - Phone:856-818-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03994200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist