=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891866539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAMIANO PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 03/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 PARKER AVE
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07011-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-546-6700
-----------------------------------------------------
Fax | 973-546-8514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 270 PARKER AVE
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07011-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-546-6700
-----------------------------------------------------
Fax | 973-546-8514
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SARA LUCIA DAMIANO
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 973-546-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 28RS00258900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28RS00258900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------