Healthcare Provider Details

I. General information

NPI: 1790436574
Provider Name (Legal Business Name): ANGELA KUZMANOSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 STATE RT 23 STE 12
KINNELON NJ
07405-1643
US

IV. Provider business mailing address

57 HIGHLAND AVE
BLOOMINGDALE NJ
07403-1129
US

V. Phone/Fax

Practice location:
  • Phone: 973-838-4444
  • Fax:
Mailing address:
  • Phone: 862-200-6562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04227400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: