Provider Demographics
NPI:1871920017
Name:PENA, DORIS H (RPH)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:H
Last Name:PENA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-3052
Mailing Address - Country:US
Mailing Address - Phone:201-791-2550
Mailing Address - Fax:201-475-2675
Practice Address - Street 1:180 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-3052
Practice Address - Country:US
Practice Address - Phone:201-791-2550
Practice Address - Fax:201-475-2675
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01957700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist