Healthcare Provider Details

I. General information

NPI: 1710479969
Provider Name (Legal Business Name): RACHEL ALEXA KASHTAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 KUSER RD
TRENTON NJ
08690-3705
US

IV. Provider business mailing address

28304 CHERRY BLOSSOM CT
LAWRENCE TOWNSHIP NJ
08648-1289
US

V. Phone/Fax

Practice location:
  • Phone: 609-585-3925
  • Fax:
Mailing address:
  • Phone: 585-748-8502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03890500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: