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General NPI Number Information
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NPI Number | 1134121809
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Entity Type | Individual
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Provider Name | DAVID S FASCIA RPH CCP
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 401 S PITNEY RD
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City | GALLOWAY
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State | NJ
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Zip | 08205-9780
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Country | US
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Telephone | 609-404-4161
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Fax | 609-404-4190
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Provider Business Mailing Address
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Address Line | 4810 OLD EGG HARBOR RD
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City | EGG HARBOR CITY
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State | NJ
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Zip | 08215-4126
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Country | US
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Telephone | 609-965-6336
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Fax | 609-965-5336
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI025634
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License Number State | NJ
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