Healthcare Provider Details

I. General information

NPI: 1427363944
Provider Name (Legal Business Name): LEONARD VAZ PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1089 WASHINGTON BLVD
ROBBINSVILLE NJ
08691-3119
US

IV. Provider business mailing address

81 WYNDMOOR DR
EAST WINDSOR NJ
08520-1259
US

V. Phone/Fax

Practice location:
  • Phone: 609-443-5505
  • Fax:
Mailing address:
  • Phone: 609-371-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01968700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: