Provider Demographics
NPI:1255766309
Name:FRASCELLA, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:FRASCELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-4601
Mailing Address - Country:US
Mailing Address - Phone:609-729-1050
Mailing Address - Fax:609-523-6595
Practice Address - Street 1:4201 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-4601
Practice Address - Country:US
Practice Address - Phone:609-729-1050
Practice Address - Fax:609-523-6595
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03588100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist