Provider Demographics
NPI:1740433473
Name:PERAINO, JOSEPH A (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:PERAINO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 AURORA DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7576
Mailing Address - Country:US
Mailing Address - Phone:609-926-7502
Mailing Address - Fax:
Practice Address - Street 1:20 COURT HOUSE SOUTH DENNIS RD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1931
Practice Address - Country:US
Practice Address - Phone:609-465-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-26
Last Update Date:2008-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02113800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6212409Medicaid