Provider Demographics
NPI:1336782663
Name:RO, CHRIS (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:RO
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 TENAFLY RD APT F
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2540
Mailing Address - Country:US
Mailing Address - Phone:201-214-0043
Mailing Address - Fax:
Practice Address - Street 1:20 W HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1788
Practice Address - Country:US
Practice Address - Phone:201-408-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04062400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist