Provider Demographics
NPI:1356019590
Name:TRUNZO, NEVINA ELIZABETH
Entity type:Individual
Prefix:
First Name:NEVINA
Middle Name:ELIZABETH
Last Name:TRUNZO
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 1:143 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HARVEYS LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18618-3146
Mailing Address - Country:US
Mailing Address - Phone:570-660-2644
Mailing Address - Fax:
Practice Address - Street 1:20 S RIVER ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1213
Practice Address - Country:US
Practice Address - Phone:570-824-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP456086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP456086OtherPHARMACIST LICENSE