Healthcare Provider Details

I. General information

NPI: 1417247214
Provider Name (Legal Business Name): PASQUALE MICHAEL PONTORIERO PHARMD, RPH, CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LOGISTICS DR STE 100
KEARNY NJ
07032-6539
US

IV. Provider business mailing address

163 SAND RD
FAIRFIELD NJ
07004-1573
US

V. Phone/Fax

Practice location:
  • Phone: 855-206-3605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03366900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: