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General NPI Number Information
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NPI Number | 1083214209
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Entity Type | Individual
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Provider Name | DR. KELLY ROTH
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Gender | Female
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 230 ROUTE 23
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City | FRANKLIN
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State | NJ
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Zip | 07416-2008
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Country | US
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Telephone | 973-209-4253
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Fax |
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Provider Business Mailing Address
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Address Line | 1 LAUREN LN
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City | SUSSEX
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State | NJ
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Zip | 07461-4116
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Country | US
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Telephone | 973-537-9743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI03586900
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License Number State | NJ
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