Provider Demographics
NPI:1013520956
Name:FASCIA, DAVID SAMUEL II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SAMUEL
Last Name:FASCIA
Suffix:II
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 1:6050 BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-9752
Mailing Address - Country:US
Mailing Address - Phone:609-484-7065
Mailing Address - Fax:609-484-8506
Practice Address - Street 1:6050 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9752
Practice Address - Country:US
Practice Address - Phone:609-484-7065
Practice Address - Fax:609-484-8506
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03810500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist