Provider Demographics
NPI:1063723815
Name:AQUINO, SUZETTE
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:AQUINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 ROUTE 130 N
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3017
Mailing Address - Country:US
Mailing Address - Phone:856-786-8694
Mailing Address - Fax:856-786-7691
Practice Address - Street 1:2604 ROUTE 130 N
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3017
Practice Address - Country:US
Practice Address - Phone:856-786-8694
Practice Address - Fax:856-786-7691
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2010-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03071300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist