Provider Demographics
NPI:1528344918
Name:HERSHGORDON, CARLIE ROSE (RPH)
Entity type:Individual
Prefix:DR
First Name:CARLIE
Middle Name:ROSE
Last Name:HERSHGORDON
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 1:2331 ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3961
Mailing Address - Country:US
Mailing Address - Phone:732-918-7812
Mailing Address - Fax:
Practice Address - Street 1:2331 ROUTE 66
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3961
Practice Address - Country:US
Practice Address - Phone:732-918-7812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03432000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist