Provider Demographics
NPI:1114779709
Name:BUZGO, EVAN JOSEPH (PHARMD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:JOSEPH
Last Name:BUZGO
Suffix:
Gender:M
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 S NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-2941
Mailing Address - Country:US
Mailing Address - Phone:919-917-4152
Mailing Address - Fax:
Practice Address - Street 1:10 S NASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2941
Practice Address - Country:US
Practice Address - Phone:919-917-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28880390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program