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General NPI Number Information
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NPI Number | 1467512210
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Entity Type | Individual
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Provider Name | MARY BETH STICKEL RPH
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 25 W SOMERSET ST
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City | RARITAN
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State | NJ
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Zip | 08869-2027
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Country | US
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Telephone | 908-722-3800
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Fax | 908-725-6825
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Provider Business Mailing Address
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Address Line | 2251 23RD ST
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City | BOULDER
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State | CO
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Zip | 80302-4650
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Country | US
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Telephone | 720-287-4775
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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 | 28RI02279300
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License Number State | NJ
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