Provider Demographics
NPI:1457300519
Name:DETURA, JAMES ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANTHONY
Last Name:DETURA
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 1:114 E CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3024
Mailing Address - Country:US
Mailing Address - Phone:201-747-0713
Mailing Address - Fax:201-384-2559
Practice Address - Street 1:114 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3024
Practice Address - Country:US
Practice Address - Phone:201-747-0713
Practice Address - Fax:201-384-2559
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist