Provider Demographics
NPI:1699092502
Name:DIFILIPPANTONIO, MARK (RPH, CIP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DIFILIPPANTONIO
Suffix:
Gender:M
Credentials:RPH, CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 CENTERTON RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-5971
Mailing Address - Country:US
Mailing Address - Phone:856-455-7020
Mailing Address - Fax:856-455-7150
Practice Address - Street 1:1070 N PEARL ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1215
Practice Address - Country:US
Practice Address - Phone:856-455-7020
Practice Address - Fax:856-455-7150
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02554400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02554400OtherNJ STATE PHARMACIST LICENSE