=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982173597
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT JOHN KERTMAN RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2018
-----------------------------------------------------
Last Update Date | 11/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 ROUTE 130 N STE 1408
-----------------------------------------------------
City | CINNAMINSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08077-3046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-829-7200
-----------------------------------------------------
Fax | 856-829-0464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 235 BELLS LAKE RD # 2
-----------------------------------------------------
City | TURNERSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08012-1683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-232-6284
-----------------------------------------------------
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 | 28RI01520100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------