Healthcare Provider Details

I. General information

NPI: 1982918132
Provider Name (Legal Business Name): MR. LEON D'AMICO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 EUROPA BLVD
CHERRY HILL NJ
08003-2675
US

IV. Provider business mailing address

102 EUROPA BLVD
CHERRY HILL NJ
08003-2675
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-6988
  • Fax: 215-739-7441
Mailing address:
  • Phone: 856-424-6988
  • Fax: 215-739-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02980300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP026614L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0003450
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: