Basic Information
| Provider Information | |||||||||
| NPI: | 1427051564 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORRITORE | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PHARM D, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 KING ST | ||||||||
| Address2: | APT 1 | ||||||||
| City: | HILLSIDE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 072053004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083545609 | ||||||||
| FaxNumber: | 7324996778 | ||||||||
| Practice Location | |||||||||
| Address1: | 136 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | CLARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070661142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325749015 | ||||||||
| FaxNumber: | 7324996778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 28RI01437100 | NJ | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.