Provider Demographics
NPI:1801110440
Name:MCNULTY, ROBERT J (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MCNULTY
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 1:283 MOHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1913
Mailing Address - Country:US
Mailing Address - Phone:908-526-1599
Mailing Address - Fax:908-707-0922
Practice Address - Street 1:283 MOHAWK TRL
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1913
Practice Address - Country:US
Practice Address - Phone:908-526-1599
Practice Address - Fax:908-707-0922
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01491200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist