Healthcare Provider Details

I. General information

NPI: 1952619520
Provider Name (Legal Business Name): BENITA KUTHIALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 S BROAD ST
HAMILTON NJ
08610-4011
US

IV. Provider business mailing address

19 TALBOT ST
SOMERSET NJ
08873-4638
US

V. Phone/Fax

Practice location:
  • Phone: 609-888-2203
  • Fax:
Mailing address:
  • Phone: 732-991-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02950000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: