Provider Demographics
NPI:1982918132
Name:D'AMICO, LEON
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:
Last Name:D'AMICO
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 1:102 EUROPA BLVD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2675
Mailing Address - Country:US
Mailing Address - Phone:856-424-6988
Mailing Address - Fax:215-739-7441
Practice Address - Street 1:102 EUROPA BLVD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2675
Practice Address - Country:US
Practice Address - Phone:856-424-6988
Practice Address - Fax:215-739-7441
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02980300183500000X
PARP026614L183500000X
DEA1-0003450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist