Provider Demographics
NPI:1154769156
Name:RUSSO, ANTHONY J (PHARM D)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:RUSSO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1526
Mailing Address - Country:US
Mailing Address - Phone:732-497-9600
Mailing Address - Fax:732-497-9107
Practice Address - Street 1:2995 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1526
Practice Address - Country:US
Practice Address - Phone:732-497-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2022-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist