Provider Demographics
NPI:1144240540
Name:VIZZONI PHARMACY L.L.C.
Entity Type:Organization
Organization Name:VIZZONI PHARMACY L.L.C.
Other - Org Name:SIEGEL'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:VIZZONI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:609-394-8111
Mailing Address - Street 1:1201 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-6231
Mailing Address - Country:US
Mailing Address - Phone:609-394-8111
Mailing Address - Fax:609-394-5022
Practice Address - Street 1:1201 S BROAD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-6231
Practice Address - Country:US
Practice Address - Phone:609-394-8111
Practice Address - Fax:609-394-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS004226003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4402006Medicaid
NJ4402006Medicaid