Healthcare Provider Details

I. General information

NPI: 1689998742
Provider Name (Legal Business Name): ROBERT ZADRA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E RIDGEWOOD AVE
RIDGEWOOD NJ
07450-3810
US

IV. Provider business mailing address

60 E RIDGEWOOD AVE
RIDGEWOOD NJ
07450-3810
US

V. Phone/Fax

Practice location:
  • Phone: 201-652-0013
  • Fax: 201-652-0020
Mailing address:
  • Phone: 201-652-0013
  • Fax: 201-652-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01480900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: