Provider Demographics
NPI:1164716452
Name:DAVANZO, ARTHUR
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:
Last Name:DAVANZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LENARD WAY
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4364
Mailing Address - Country:US
Mailing Address - Phone:973-386-5958
Mailing Address - Fax:
Practice Address - Street 1:808 ROUTE 46 WEST
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4364
Practice Address - Country:US
Practice Address - Phone:973-386-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01884800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist