Healthcare Provider Details

I. General information

NPI: 1801549852
Provider Name (Legal Business Name): RICHARD A KUCAB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 PENNINGTON RD
PENNINGTON NJ
08534-3216
US

IV. Provider business mailing address

16 PILGRIM CT
EWING NJ
08628-3607
US

V. Phone/Fax

Practice location:
  • Phone: 609-737-0606
  • Fax:
Mailing address:
  • Phone: 609-532-2568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01502700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: