Healthcare Provider Details

I. General information

NPI: 1689399909
Provider Name (Legal Business Name): ROSE JONATHAN MARWA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 GEORGES RD
DAYTON NJ
08810-1639
US

IV. Provider business mailing address

365 GEORGES RD
DAYTON NJ
08810-1639
US

V. Phone/Fax

Practice location:
  • Phone: 732-329-2626
  • Fax: 732-329-2215
Mailing address:
  • Phone: 732-329-2626
  • Fax: 732-329-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03675800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: