Provider Demographics
NPI:1023374931
Name:PUCCI, PHILLIP ANTHONY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:PUCCI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-4217
Mailing Address - Country:US
Mailing Address - Phone:724-384-0766
Mailing Address - Fax:724-581-4809
Practice Address - Street 1:1314 7TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-4217
Practice Address - Country:US
Practice Address - Phone:724-384-0766
Practice Address - Fax:724-581-4809
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist