Healthcare Provider Details

I. General information

NPI: 1033321393
Provider Name (Legal Business Name): ROBERT RUGGERO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HADDON AVE
CAMDEN NJ
08103-3101
US

IV. Provider business mailing address

264 SUNNY JIM DR
MEDFORD NJ
08055-9251
US

V. Phone/Fax

Practice location:
  • Phone: 856-580-6331
  • Fax: 856-635-2400
Mailing address:
  • Phone: 856-580-6331
  • Fax: 856-635-2400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01401100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: