Provider Demographics
NPI:1487240644
Name:KEROLUS, BESHOI
Entity type:Individual
Prefix:
First Name:BESHOI
Middle Name:
Last Name:KEROLUS
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 1:10 FERNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3333
Mailing Address - Country:US
Mailing Address - Phone:718-869-1214
Mailing Address - Fax:
Practice Address - Street 1:2 CENTER PLZ
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-9744
Practice Address - Country:US
Practice Address - Phone:718-869-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04054000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist