Provider Demographics
NPI:1336453430
Name:LAGOMARSINO, DENNIS S
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:S
Last Name:LAGOMARSINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NASSAU PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5991
Mailing Address - Country:US
Mailing Address - Phone:609-951-0274
Mailing Address - Fax:609-951-0274
Practice Address - Street 1:500 NASSAU PARK BLVD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5991
Practice Address - Country:US
Practice Address - Phone:609-951-0274
Practice Address - Fax:609-951-0274
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02088900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist