Provider Demographics
NPI:1275387672
Name:PONZINI, EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:PONZINI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 BLACK OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6400
Mailing Address - Country:US
Mailing Address - Phone:973-837-8770
Mailing Address - Fax:973-837-8771
Practice Address - Street 1:879 BLACK OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6400
Practice Address - Country:US
Practice Address - Phone:973-837-8770
Practice Address - Fax:973-837-8771
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02019200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist