Provider Demographics
NPI:1619147857
Name:REVERENDO, ALDA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ALDA
Middle Name:
Last Name:REVERENDO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1105
Mailing Address - Country:US
Mailing Address - Phone:201-991-4409
Mailing Address - Fax:201-955-1117
Practice Address - Street 1:145 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-1105
Practice Address - Country:US
Practice Address - Phone:201-991-4409
Practice Address - Fax:201-955-1117
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02215000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist