Provider Demographics
NPI:1801549852
Name:KUCAB, RICHARD A
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:KUCAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PILGRIM CT
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3607
Mailing Address - Country:US
Mailing Address - Phone:609-532-2568
Mailing Address - Fax:
Practice Address - Street 1:2555 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-3216
Practice Address - Country:US
Practice Address - Phone:609-737-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01502700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist