Provider Demographics
NPI:1942242235
Name:VIZZONI PHARMACY LLC
Entity Type:Organization
Organization Name:VIZZONI PHARMACY LLC
Other - Org Name:ALLENTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPIC
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIZZONI
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:609-259-6121
Mailing Address - Street 1:2 S MAIN ST
Mailing Address - Street 2:PO BOX 146
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-1610
Mailing Address - Country:US
Mailing Address - Phone:609-259-6121
Mailing Address - Fax:609-258-9640
Practice Address - Street 1:2 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501-1610
Practice Address - Country:US
Practice Address - Phone:609-259-6121
Practice Address - Fax:609-259-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006393003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0059226Medicaid
2054915OtherPK
2054915OtherPK