Provider Demographics
NPI:1548281694
Name:VIZZONI'S PHARMACY L.L.C
Entity type:Organization
Organization Name:VIZZONI'S PHARMACY L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:VIZZONI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:609-394-5784
Mailing Address - Street 1:1616 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-6036
Mailing Address - Country:US
Mailing Address - Phone:609-394-5784
Mailing Address - Fax:609-394-5131
Practice Address - Street 1:1616 S BROAD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-6036
Practice Address - Country:US
Practice Address - Phone:609-394-5784
Practice Address - Fax:609-394-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00330200333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4287703Medicaid
NJ4287703Medicaid