Provider Demographics
NPI:1952537607
Name:DECRUZ, LIONEL (RPH)
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:
Last Name:DECRUZ
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 1:13 THROOP AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8520
Mailing Address - Country:US
Mailing Address - Phone:732-723-1376
Mailing Address - Fax:732-607-7516
Practice Address - Street 1:3891 ROUTE 516
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2499
Practice Address - Country:US
Practice Address - Phone:732-607-7510
Practice Address - Fax:732-607-7516
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01623100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist