Provider Demographics
NPI:1841894797
Name:CARUSO, MICHAEL GEORGE (PHARMD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:CARUSO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MARY AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2858
Mailing Address - Country:US
Mailing Address - Phone:973-650-2725
Mailing Address - Fax:
Practice Address - Street 1:343 W MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2730
Practice Address - Country:US
Practice Address - Phone:973-992-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02758700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist