Healthcare Provider Details

I. General information

NPI: 1598909517
Provider Name (Legal Business Name): ROY C PUTRINO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 VALLEY ROAD 4TH FLOOR
WAYNE NJ
07470-2037
US

IV. Provider business mailing address

1401 VALLEY RD FL 4
WAYNE NJ
07470-2037
US

V. Phone/Fax

Practice location:
  • Phone: 201-475-0500
  • Fax: 201-475-9630
Mailing address:
  • Phone: 201-475-0500
  • Fax: 201-475-9630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01634000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: