1154545689 NPI number — MR. RONALD VADURRO R.P.

Table of content: MR. RONALD VADURRO R.P. (NPI 1154545689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154545689 NPI number — MR. RONALD VADURRO R.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VADURRO
Provider First Name:
RONALD
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.P.
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:
1154545689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 WOODLAND TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLYN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08107-1518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-854-5156
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N BLACKHORSE PIKE
Provider Second Line Business Practice Location Address:
ACME SAV-0N PHARMACY
Provider Business Practice Location Address City Name:
AUDUBON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08106-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-616-2484
Provider Business Practice Location Address Fax Number:
856-310-1507
Provider Enumeration Date:
04/13/2007

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:  28RI01654700 , 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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