Provider Demographics
NPI:1285856534
Name:RUSULOJ, GEORGE JUNIOR (PHARM D)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:JUNIOR
Last Name:RUSULOJ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:JUNIOR
Other - Last Name:DOUBERLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 BAYBERRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:973-568-8692
Mailing Address - Fax:732-985-3609
Practice Address - Street 1:1907 ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817
Practice Address - Country:US
Practice Address - Phone:732-985-1211
Practice Address - Fax:732-985-3609
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03079800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03079800OtherSTATE LICENSE NUMBER