Healthcare Provider Details

I. General information

NPI: 1114779709
Provider Name (Legal Business Name): EVAN JOSEPH BUZGO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S NASHVILLE AVE
VENTNOR CITY NJ
08406-2941
US

IV. Provider business mailing address

10 S NASHVILLE AVE
VENTNOR CITY NJ
08406-2941
US

V. Phone/Fax

Practice location:
  • Phone: 919-917-4152
  • Fax:
Mailing address:
  • Phone: 919-917-4152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number28880
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: