Provider Demographics
NPI:1336423847
Name:SOUS, PETER (RPH)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SOUS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:MERIT
Other - Middle Name:
Other - Last Name:SOOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 EDGEWATER TOWNE CTR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1246
Mailing Address - Country:US
Mailing Address - Phone:201-941-2050
Mailing Address - Fax:201-941-2215
Practice Address - Street 1:432 BERGEN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-2291
Practice Address - Country:US
Practice Address - Phone:973-483-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03459900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist