Provider Demographics
NPI:1447854914
Name:MEDORI-FOGARINO, NORINA
Entity type:Individual
Prefix:
First Name:NORINA
Middle Name:
Last Name:MEDORI-FOGARINO
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 1:39 TINSMITH LN
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1320
Mailing Address - Country:US
Mailing Address - Phone:609-220-3982
Mailing Address - Fax:
Practice Address - Street 1:416 W CUTHBERT BLVD
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-3327
Practice Address - Country:US
Practice Address - Phone:856-854-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01801800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty