Healthcare Provider Details

I. General information

NPI: 1689080509
Provider Name (Legal Business Name): ANTHONY CORTELLESSA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NEW JERSEY AVE
WILDWOOD NJ
08260-6116
US

IV. Provider business mailing address

137 PINE VALLEY RD
CHERRY HILL NJ
08034-2816
US

V. Phone/Fax

Practice location:
  • Phone: 609-729-0162
  • Fax: 609-729-4682
Mailing address:
  • Phone: 856-427-6923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03529700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: