Provider Demographics
NPI:1336378728
Name:P3 NUTRITIONALS,LLC
Entity Type:Organization
Organization Name:P3 NUTRITIONALS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PACITTI
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:609-330-9391
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-0319
Mailing Address - Country:US
Mailing Address - Phone:609-330-9391
Mailing Address - Fax:
Practice Address - Street 1:1000 WHITE HORSE RD
Practice Address - Street 2:SUITE 902
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4406
Practice Address - Country:US
Practice Address - Phone:609-330-9391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center