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General NPI Number Information
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NPI Number | 1588790612
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Entity Type | Individual
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Provider Name | FANNY A. MUSTO R.PH.
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Gender | Female
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Dates
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Enumeration Date | 02/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1409 WICKAPECKO DR
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City | OCEAN
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State | NJ
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Zip | 07712-4201
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Country | US
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Telephone | 732-776-6070
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Fax |
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Provider Business Mailing Address
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Address Line | 30 MILLBROOK DR
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-2226
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Country | US
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Telephone | 732-706-3775
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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 | 28RI02283300
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License Number State | NJ
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