Provider Demographics
NPI:1205423811
Name:IACARUSO, EILEEN MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:MARIE
Last Name:IACARUSO
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 1:5 SHETLAND PATH
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3113
Mailing Address - Country:US
Mailing Address - Phone:856-404-1323
Mailing Address - Fax:
Practice Address - Street 1:24 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:MOUNT EPHRAIM
Practice Address - State:NJ
Practice Address - Zip Code:08059-1321
Practice Address - Country:US
Practice Address - Phone:856-931-6262
Practice Address - Fax:856-931-1056
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RJ04115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist