Provider Demographics
NPI:1083352082
Name:DEMARZO, AMANDA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:DEMARZO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CONISTON CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2482
Mailing Address - Country:US
Mailing Address - Phone:201-899-1821
Mailing Address - Fax:
Practice Address - Street 1:181 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1830
Practice Address - Country:US
Practice Address - Phone:201-899-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04229900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist