Healthcare Provider Details

I. General information

NPI: 1407139165
Provider Name (Legal Business Name): CHERYL HSU PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RENNER AVE
BLOOMFIELD NJ
07003
US

IV. Provider business mailing address

100 RENNER AVE
BLOOMFIELD NJ
07003-5445
US

V. Phone/Fax

Practice location:
  • Phone: 973-220-9203
  • Fax:
Mailing address:
  • Phone: 973-220-9203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03313300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: