=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457945040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNYS TAPIA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2021
-----------------------------------------------------
Last Update Date | 02/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 STATE ROUTE 10
-----------------------------------------------------
City | RANDOLPH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07869-1916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-895-3401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 MAX DR APT 11A
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-3036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-370-4060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI04108500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------