Healthcare Provider Details

I. General information

NPI: 1669260212
Provider Name (Legal Business Name): STEPHANIE ARADID RUVALCABA RODRIGUEZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROBERT WOOD JOHNSON PL
NEW BRUNSWICK NJ
08901-1928
US

IV. Provider business mailing address

1 ROBERT WOOD JOHNSON PL
NEW BRUNSWICK NJ
08901-1928
US

V. Phone/Fax

Practice location:
  • Phone: 732-828-3000
  • Fax: 732-253-3410
Mailing address:
  • Phone: 732-828-3000
  • Fax: 732-253-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04342500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: