Provider Demographics
NPI:1255463790
Name:DIAMORE, JAMES L (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
Last Name:DIAMORE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NEW BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-2545
Mailing Address - Country:US
Mailing Address - Phone:856-456-6121
Mailing Address - Fax:856-742-1845
Practice Address - Street 1:101 NEW BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLAWN
Practice Address - State:NJ
Practice Address - Zip Code:08030-2545
Practice Address - Country:US
Practice Address - Phone:856-456-6121
Practice Address - Fax:856-742-1845
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01398500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3107302OtherNCPDP
NJ4360605Medicaid
NJ4360605Medicaid