Provider Demographics
NPI:1891866539
Name:DAMIANO PHARMACY
Entity Type:Organization
Organization Name:DAMIANO PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:DAMIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:973-546-6700
Mailing Address - Street 1:270 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1400
Mailing Address - Country:US
Mailing Address - Phone:973-546-6700
Mailing Address - Fax:973-546-8514
Practice Address - Street 1:270 PARKER AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1400
Practice Address - Country:US
Practice Address - Phone:973-546-6700
Practice Address - Fax:973-546-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00258900332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4269004Medicaid
NJ2526107OtherMEDICAID DME
NJ4269004Medicaid