Provider Demographics
NPI:1710268313
Name:PACQUIAO, DAVID (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:PACQUIAO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 TINGLEY LN
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1479
Mailing Address - Country:US
Mailing Address - Phone:908-578-3962
Mailing Address - Fax:
Practice Address - Street 1:520 CONVERY BLVD
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3021
Practice Address - Country:US
Practice Address - Phone:732-826-9222
Practice Address - Fax:732-293-0177
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03230500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist