Healthcare Provider Details

I. General information

NPI: 1033594833
Provider Name (Legal Business Name): JESSICA BUZZELLI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 SPRINGFIELD AVE
SUMMIT NJ
07901-4602
US

IV. Provider business mailing address

364 SPRINGFIELD AVE
SUMMIT NJ
07901-4602
US

V. Phone/Fax

Practice location:
  • Phone: 908-277-2092
  • Fax: 908-277-2592
Mailing address:
  • Phone: 908-277-2092
  • Fax: 908-277-2592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02973300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: