Provider Demographics
NPI:1962136978
Name:PEZZULO, ANTHONY D (RPH)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:PEZZULO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 HIDDEN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3843
Mailing Address - Country:US
Mailing Address - Phone:973-610-5982
Mailing Address - Fax:
Practice Address - Street 1:37 HIDDEN GLEN DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3843
Practice Address - Country:US
Practice Address - Phone:973-610-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355451835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care