Provider Demographics
NPI:1134121809
Name:FASCIA, DAVID S (RPH CCP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:S
Last Name:FASCIA
Suffix:
Gender:M
Credentials:RPH CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 OLD EGG HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08215-4126
Mailing Address - Country:US
Mailing Address - Phone:609-965-6336
Mailing Address - Fax:609-965-5336
Practice Address - Street 1:401 S PITNEY RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9780
Practice Address - Country:US
Practice Address - Phone:609-404-4161
Practice Address - Fax:609-404-4190
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI025634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist