Provider Demographics
NPI:1528388527
Name:DEISS, PAMELA ELIZABETH (RPH, CIP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:DEISS
Suffix:
Gender:F
Credentials:RPH, CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-1118
Mailing Address - Country:US
Mailing Address - Phone:609-448-4545
Mailing Address - Fax:
Practice Address - Street 1:1801 KUSER RD
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08690
Practice Address - Country:US
Practice Address - Phone:609-585-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10519183500000X
NJ28RI01930700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist