1093099665 NPI number — DR. JOHN LOUIS COLAIZZI JR. PHARMD, CCP

Table of content: DR. JOHN LOUIS COLAIZZI JR. PHARMD, CCP (NPI 1093099665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093099665 NPI number — DR. JOHN LOUIS COLAIZZI JR. PHARMD, CCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLAIZZI
Provider First Name:
JOHN
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PHARMD, CCP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093099665
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 KING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN LAKES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07417-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-891-3371
Provider Business Mailing Address Fax Number:
973-376-3874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
899 MOUNTAIN AVE
Provider Second Line Business Practice Location Address:
WALGREEN CO,
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-376-7724
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RI28577 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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