Healthcare Provider Details

I. General information

NPI: 1699092502
Provider Name (Legal Business Name): MARK DIFILIPPANTONIO RPH, CIP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2010
Last Update Date: 05/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 N PEARL ST
BRIDGETON NJ
08302-1215
US

IV. Provider business mailing address

393 CENTERTON RD
BRIDGETON NJ
08302-5971
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-7020
  • Fax: 856-455-7150
Mailing address:
  • Phone: 856-455-7020
  • Fax: 856-455-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02554400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: