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General NPI Number Information
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NPI Number | 1598805459
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Entity Type | Individual
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Provider Name | WILLIAM GENNARO DEEGAN R.PH.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 32 W MADISON AVE
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City | DUMONT
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State | NJ
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Zip | 07628-2327
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Country | US
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Telephone | 201-387-6633
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Fax | 201-387-1776
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Provider Business Mailing Address
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Address Line | 11 BETHANY CIR
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City | CLOSTER
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State | NJ
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Zip | 07624-1665
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Country | US
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Telephone | 201-768-9534
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Fax | 201-387-1776
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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 | 27242
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License Number State | NJ
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