Provider Demographics
NPI:1649547621
Name:PULLEN, ERIC BRIAN (RP)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:BRIAN
Last Name:PULLEN
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HOMESTEAD DRIVE SUITE F
Mailing Address - Street 2:BOYDS PHARMACY OF MANSFIELD,INC
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022
Mailing Address - Country:US
Mailing Address - Phone:609-298-7474
Mailing Address - Fax:609-298-6811
Practice Address - Street 1:25 HOMESTEAD DRIVE SUITE F
Practice Address - Street 2:BOYDS PHARMACY OF MANSFIELD,INC
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022
Practice Address - Country:US
Practice Address - Phone:609-298-7474
Practice Address - Fax:609-298-6811
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01991800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4394101Medicaid