Basic Information
| Provider Information | |||||||||
| NPI: | 1518143072 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CERULLI-PAGNOTTA | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARM.D, RPH, AE-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 DELAWARE AVE | ||||||||
| Address2: | FOUR CORNERS PHARMACY | ||||||||
| City: | DELMAR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120541918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184398200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 340 DELAWARE AVE | ||||||||
| Address2: | FOUR CORNERS PHARMACY | ||||||||
| City: | DELMAR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120541918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184398200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2008 | ||||||||
| LastUpdateDate: | 01/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 042054 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.