Provider Demographics
NPI:1366723967
Name:DILAURI, DAMIAN JOSEPH (RPH)
Entity type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:JOSEPH
Last Name:DILAURI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:DAMIAN
Other - Middle Name:JOSEPH
Other - Last Name:DILAURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:679 MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1453
Mailing Address - Country:US
Mailing Address - Phone:201-225-1077
Mailing Address - Fax:
Practice Address - Street 1:679 MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1453
Practice Address - Country:US
Practice Address - Phone:201-225-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RJ00566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLISALISA679Medicare UPIN