Provider Demographics
NPI:1679387690
Name:POTESTIO, BRIANNA KRISTEN
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:KRISTEN
Last Name:POTESTIO
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 1:1300 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-3308
Mailing Address - Country:US
Mailing Address - Phone:201-798-0558
Mailing Address - Fax:
Practice Address - Street 1:1300 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3308
Practice Address - Country:US
Practice Address - Phone:201-798-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04410400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist