Provider Demographics
NPI:1922088939
Name:DECARLO, DAVID J JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:DECARLO
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:116 FOXHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-1611
Mailing Address - Country:US
Mailing Address - Phone:732-367-5222
Mailing Address - Fax:732-367-3393
Practice Address - Street 1:1000 ROUTE 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5961
Practice Address - Country:US
Practice Address - Phone:732-367-5222
Practice Address - Fax:732-367-3393
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ28RI01651100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist