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: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 AIRPORT RD
LAKEWOOD NJ
08701-6927
US

IV. Provider business mailing address

16 GLESS AVE
NUTLEY NJ
07110-3214
US

V. Phone/Fax

Practice location:
  • Phone: 732-256-9660
  • Fax: 732-256-9659
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number28RI03366900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: