Healthcare Provider Details

I. General information

NPI: 1497887418
Provider Name (Legal Business Name): JAMES L. DIAMORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 06/17/2008
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 Code333600000X
TaxonomyPharmacy
License Number28RS00356800
License Number StateNJ

VIII. Authorized Official

Name: MR. JAMES L DIAMORE
Title or Position: OWNER
Credential: RPH
Phone: 856-456-6121