Provider Demographics
NPI:1063792554
Name:LIGHTCAP, ROBERT B JR
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:B
Last Name:LIGHTCAP
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FAWN HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2819
Mailing Address - Country:US
Mailing Address - Phone:856-223-1856
Mailing Address - Fax:
Practice Address - Street 1:26 FAWN HOLLOW LN
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-2819
Practice Address - Country:US
Practice Address - Phone:856-223-1856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02866400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist