Provider Demographics
NPI:1245553817
Name:CIFUENTES, DAWN (RPH)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:CIFUENTES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 BALTUSROL WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1617
Mailing Address - Country:US
Mailing Address - Phone:908-685-1052
Mailing Address - Fax:
Practice Address - Street 1:45 ROUTE 46
Practice Address - Street 2:SUITE 609
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9390
Practice Address - Country:US
Practice Address - Phone:973-276-0254
Practice Address - Fax:973-276-0998
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02417800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist