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General NPI Number Information
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NPI Number | 1407908288
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Entity Type | Individual
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Provider Name | ANTONIO M DISANTO RPH
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 509 ELIZABETH AVE
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City | ELIZABETH
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State | NJ
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Zip | 07206-1130
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Country | US
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Telephone | 908-355-1784
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Fax |
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Provider Business Mailing Address
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Address Line | 706 CURTIS AVE
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City | EDISON
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State | NJ
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Zip | 08820-2344
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Country | US
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Telephone | 732-548-4914
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Fax |
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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 | RI16411
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License Number State | NJ
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