Healthcare Provider Details

I. General information

NPI: 1528388527
Provider Name (Legal Business Name): PAMELA ELIZABETH DEISS RPH, CIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 KUSER RD
MERCERVILLE NJ
08690
US

IV. Provider business mailing address

4 SURREY LN
EAST WINDSOR NJ
08520-1118
US

V. Phone/Fax

Practice location:
  • Phone: 609-585-3925
  • Fax:
Mailing address:
  • Phone: 609-448-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10519
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01930700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: