Provider Demographics
NPI:1033813910
Name:COCOLI, RUDINA
Entity Type:Individual
Prefix:
First Name:RUDINA
Middle Name:
Last Name:COCOLI
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 1:18 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1560
Mailing Address - Country:US
Mailing Address - Phone:347-350-3761
Mailing Address - Fax:
Practice Address - Street 1:1333 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3903
Practice Address - Country:US
Practice Address - Phone:914-834-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist