Provider Demographics
NPI:1598805459
Name:DEEGAN, WILLIAM GENNARO (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GENNARO
Last Name:DEEGAN
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 1:11 BETHANY CIR
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1665
Mailing Address - Country:US
Mailing Address - Phone:201-768-9534
Mailing Address - Fax:201-387-1776
Practice Address - Street 1:32 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2327
Practice Address - Country:US
Practice Address - Phone:201-387-6633
Practice Address - Fax:201-387-1776
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31426854OtherNCPDP