Healthcare Provider Details

I. General information

NPI: 1972195089
Provider Name (Legal Business Name): KRISTEN L. SCARPA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/14/2021
Certification Date: 02/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 AMBOY AVE STE 2
WOODBRIDGE NJ
07095-2948
US

IV. Provider business mailing address

458 AMBOY AVE STE 2
WOODBRIDGE NJ
07095-2948
US

V. Phone/Fax

Practice location:
  • Phone: 732-636-0011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number28RI02847600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02847600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: