Provider Demographics
NPI:1639480478
Name:MEDAGLIA, NANCY DUDAS
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:DUDAS
Last Name:MEDAGLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5448
Mailing Address - Country:US
Mailing Address - Phone:908-822-9300
Mailing Address - Fax:908-822-9309
Practice Address - Street 1:2301 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5448
Practice Address - Country:US
Practice Address - Phone:908-822-9300
Practice Address - Fax:908-822-9309
Is Sole Proprietor?:No
Enumeration Date:2010-06-26
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01484500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist