Provider Demographics
NPI:1952624108
Name:UTITUS, TARA MICHELLE (RPH)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELLE
Last Name:UTITUS
Suffix:
Gender:F
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:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:ALLAMUCHY
Mailing Address - State:NJ
Mailing Address - Zip Code:07820-0399
Mailing Address - Country:US
Mailing Address - Phone:908-852-8818
Mailing Address - Fax:908-852-8775
Practice Address - Street 1:ROUTE 517
Practice Address - Street 2:VILLAGE SQUARE MALL
Practice Address - City:ALLAMUCHY
Practice Address - State:NJ
Practice Address - Zip Code:07820
Practice Address - Country:US
Practice Address - Phone:908-852-8818
Practice Address - Fax:908-852-8775
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI002616100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist