Provider Demographics
NPI:1649862798
Name:BERTONAZZI, ABIGAIL LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:LYNN
Last Name:BERTONAZZI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5386 GENOA AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7924
Mailing Address - Country:US
Mailing Address - Phone:856-207-2530
Mailing Address - Fax:
Practice Address - Street 1:11 COURT HOUSE SOUTH DENNIS RD STE 9
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2150
Practice Address - Country:US
Practice Address - Phone:609-465-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03790800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist