Provider Demographics
NPI:1316267198
Name:RENGASWAMY, LATHA R (RPH)
Entity type:Individual
Prefix:
First Name:LATHA
Middle Name:R
Last Name:RENGASWAMY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 OLD BEEKMAN RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-3114
Mailing Address - Country:US
Mailing Address - Phone:732-666-3781
Mailing Address - Fax:
Practice Address - Street 1:314 APPLEGARTH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-3847
Practice Address - Country:US
Practice Address - Phone:609-655-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03342600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist