Provider Demographics
NPI:1669076279
Name:OONNITTAN, DERICK V (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:DERICK
Middle Name:V
Last Name:OONNITTAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 US HIGHWAY 22
Mailing Address - Street 2:PHARMACY DERICK OONNITTAN
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865
Mailing Address - Country:US
Mailing Address - Phone:908-859-8331
Mailing Address - Fax:
Practice Address - Street 1:1278 US HIGHWAY 22
Practice Address - Street 2:PHARMACY DERICK OONNITTAN
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-0886
Practice Address - Country:US
Practice Address - Phone:908-859-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04062100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist