Provider Demographics
NPI:1548019052
Name:CANTAGALLO, SUSAN M (RPH)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:CANTAGALLO
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 1:221 MILLSTONE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:PERRINEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08535-9990
Mailing Address - Country:US
Mailing Address - Phone:732-851-4101
Mailing Address - Fax:732-851-4103
Practice Address - Street 1:221 MILLSTONE RD STE 8
Practice Address - Street 2:
Practice Address - City:PERRINEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08535-9990
Practice Address - Country:US
Practice Address - Phone:732-851-4101
Practice Address - Fax:732-851-4103
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS02001100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist