Provider Demographics
NPI:1013230960
Name:MONFASANI, PETER C (RPH)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:C
Last Name:MONFASANI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TWINBROOKS CT
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1837
Mailing Address - Country:US
Mailing Address - Phone:732-671-4713
Mailing Address - Fax:
Practice Address - Street 1:272 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1619
Practice Address - Country:US
Practice Address - Phone:212-255-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist