Healthcare Provider Details

I. General information

NPI: 1871807396
Provider Name (Legal Business Name): SUSAN EARDLEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BOULEVARD
HASBROUCK HEIGHTS NJ
07604-1518
US

IV. Provider business mailing address

81 WOODLAWN AVE
CLIFTON NJ
07013-4010
US

V. Phone/Fax

Practice location:
  • Phone: 201-288-0404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRI02614700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: