Healthcare Provider Details

I. General information

NPI: 1376150011
Provider Name (Legal Business Name): RYTEN RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2020
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
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: 732-636-2873
Mailing address:
  • Phone: 732-636-0011
  • Fax: 732-636-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTEN L. SCARPA
Title or Position: PRESIDENT
Credential:
Phone: 732-636-0011