Provider Demographics
NPI:1871679266
Name:POMARICO, BRENT T (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:T
Last Name:POMARICO
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 1:239 OLD BERGEN RD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2620
Mailing Address - Country:US
Mailing Address - Phone:201-434-8062
Mailing Address - Fax:201-434-7596
Practice Address - Street 1:239 OLD BERGEN RD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2620
Practice Address - Country:US
Practice Address - Phone:201-434-8062
Practice Address - Fax:201-434-7596
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI02425000183500000X
FLPS39395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist