Provider Demographics
NPI:1770898645
Name:GOSS, STUART (RPH)
Entity type:Individual
Prefix:MR
First Name:STUART
Middle Name:
Last Name:GOSS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SANIBEL LN
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-3748
Mailing Address - Country:US
Mailing Address - Phone:609-223-0576
Mailing Address - Fax:928-223-0579
Practice Address - Street 1:1091 S BROAD ST
Practice Address - Street 2:RITE AID STORE 03324
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-1461
Practice Address - Country:US
Practice Address - Phone:609-393-3386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03168600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist