Healthcare Provider Details

I. General information

NPI: 1073605531
Provider Name (Legal Business Name): TARA A TRABULSI PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 MAIN STREET
LITTLE FERRY NJ
07643
US

IV. Provider business mailing address

84 HILL STREET
MIDLAND PK NJ
07432
US

V. Phone/Fax

Practice location:
  • Phone: 201-641-7200
  • Fax: 201-641-2939
Mailing address:
  • Phone: 201-251-2102
  • Fax: 201-641-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03083100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: