Provider Demographics
NPI:1316522790
Name:CENTENO, LUCIANO (PHARMD)
Entity type:Individual
Prefix:
First Name:LUCIANO
Middle Name:
Last Name:CENTENO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 SAINT JOHNS PL APT 2R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-3911
Mailing Address - Country:US
Mailing Address - Phone:718-314-7270
Mailing Address - Fax:
Practice Address - Street 1:1041 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1155
Practice Address - Country:US
Practice Address - Phone:973-237-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04130700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist