Healthcare Provider Details

I. General information

NPI: 1255463790
Provider Name (Legal Business Name): JAMES L DIAMORE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NEW BROADWAY
BROOKLAWN NJ
08030-2545
US

IV. Provider business mailing address

101 NEW BROADWAY
BROOKLAWN NJ
08030-2545
US

V. Phone/Fax

Practice location:
  • Phone: 856-456-6121
  • Fax: 856-742-1845
Mailing address:
  • Phone: 856-456-6121
  • Fax: 856-742-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01398500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: