Provider Demographics
NPI:1417247214
Name:PONTORIERO, PASQUALE MICHAEL (PHARMD, RPH, CCP)
Entity Type:Individual
Prefix:DR
First Name:PASQUALE
Middle Name:MICHAEL
Last Name:PONTORIERO
Suffix:
Gender:M
Credentials:PHARMD, RPH, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GLESS AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-6927
Practice Address - Country:US
Practice Address - Phone:732-256-9660
Practice Address - Fax:732-256-9659
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI033669001835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric