=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922627587
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIKEHLA GUBITOSA PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2020
-----------------------------------------------------
Last Update Date | 04/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 61 FERRY ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07105-1805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-465-0482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 ROBERT WOOD JOHNSON PL # 12097
-----------------------------------------------------
City | NEW BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08901-1928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-246-1745
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI03962200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------