Provider Demographics
NPI:1871802728
Name:SCILLATH, SANDRA MARCY (RPH)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARCY
Last Name:SCILLATH
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 1:882 CHIVAS DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3582
Mailing Address - Country:US
Mailing Address - Phone:732-929-8876
Mailing Address - Fax:
Practice Address - Street 1:882 CHIVAS DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3582
Practice Address - Country:US
Practice Address - Phone:732-929-8876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01967200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist