Healthcare Provider Details

I. General information

NPI: 1720975337
Provider Name (Legal Business Name): RODOLFO SENO OMPOD III RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W MAIN ST
FREEHOLD NJ
07728-2519
US

IV. Provider business mailing address

72 FORTUNE CT
TOMS RIVER NJ
08755-1491
US

V. Phone/Fax

Practice location:
  • Phone: 732-462-5841
  • Fax:
Mailing address:
  • Phone: 732-581-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04436900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: