Provider Demographics
NPI:1497887418
Name:JAMES L. DIAMORE
Entity Type:Organization
Organization Name:JAMES L. DIAMORE
Other - Org Name:LIPKINS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIAMORE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:856-456-6121
Mailing Address - Street 1:101 NEW BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-2545
Mailing Address - Country:US
Mailing Address - Phone:856-456-6121
Mailing Address - Fax:856-742-1845
Practice Address - Street 1:101 NEW BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLAWN
Practice Address - State:NJ
Practice Address - Zip Code:08030-2545
Practice Address - Country:US
Practice Address - Phone:856-456-6121
Practice Address - Fax:856-742-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00356800333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4360605Medicaid
NJ3107302OtherNCPDP
NJ4360605Medicaid