Organization Name: | PROFESSIONAL PAIN MANAGEMENT DISPENSARY |
NPI Number: | 1083006886 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PETER CORDA (OWNER) |
Mailing Address: | 2007 N Black Horse Pike Williamstown |
State: | NJ US |
Postal Code: | 080949120 |
Phone Number: | 8567404888 |
Fax Number: | 8567400558 |
NPI Enumeration Date: | 03/03/2015 |
NPI Last Update Date: | 03/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0002X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Clinic Pharmacy |
Taxonomy Definition: | A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |