Active NPI
Randa Wisa
- Pharmacist
- East Brunswick, NJ
National Provider Identifier
1831626530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI03792000
- Practice address
- 1004 Commons Dr
East Brunswick, NJ 08816-5217 - Phone
- (732) 485-9570
- NPI assigned
- May 12, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RJ06843 | NJ | |
| Pharmacist | 183500000X | 28RI03792000 | NJ | Primary |
Addresses
Primary practice location
1004 Commons Dr
East Brunswick, NJ 08816-5217
Mailing address
1004 Commons Dr
East Brunswick, NJ 08816-5217
Phone (732) 485-9570
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI03792000 | NJ | MD | Pharmacist |
| 28RJ06843 | NJ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Maria Pharmacy | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Health Maintenance Organization
- East Brunswick, NJ
- NPI 1972038446
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494547200000",
"number": "1831626530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1004 COMMONS DR",
"city": "EAST BRUNSWICK",
"state": "NJ",
"postal_code": "088165217",
"telephone_number": "732-485-9570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1004 COMMONS DR",
"city": "EAST BRUNSWICK",
"state": "NJ",
"postal_code": "088165217",
"telephone_number": "732-485-9570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISA",
"first_name": "RANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-12",
"last_updated": "2017-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RJ06843",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI03792000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Brunswick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.