Provider Demographics
NPI:1548308018
Name:IGNAZZI, NICHOLAS SR
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:IGNAZZI
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 KINDERKAMACK ROAD
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649
Mailing Address - Country:US
Mailing Address - Phone:201-262-1800
Mailing Address - Fax:201-262-1596
Practice Address - Street 1:223 KINDERKAMACK ROAD
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649
Practice Address - Country:US
Practice Address - Phone:201-262-1800
Practice Address - Fax:201-262-1596
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01423400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01423400OtherPHARMACIST LICENSE