Provider Demographics
NPI:1053426510
Name:DITURI, VITO ANGELO (RPH)
Entity type:Individual
Prefix:MR
First Name:VITO
Middle Name:ANGELO
Last Name:DITURI
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 1:393 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2842
Mailing Address - Country:US
Mailing Address - Phone:973-757-1200
Mailing Address - Fax:973-757-1201
Practice Address - Street 1:393 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2842
Practice Address - Country:US
Practice Address - Phone:973-757-1200
Practice Address - Fax:973-757-1201
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03009600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00657800OtherPHARMACY LICENSE NUMBER
NJ0099694Medicaid
NJ0099716Medicaid
NJ0099694Medicaid
NJ5670110001Medicare NSC