Provider Demographics
NPI:1144714460
Name:RIZZO, DANIELLE I
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:RIZZO
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 NATALIE WAY
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5250
Mailing Address - Country:US
Mailing Address - Phone:917-838-9352
Mailing Address - Fax:
Practice Address - Street 1:21 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-1121
Practice Address - Country:US
Practice Address - Phone:917-838-9351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO2523700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RIO2523700OtherSTATE BOARD OF PHARMACY