Provider Demographics
NPI:1093584757
Name:BELLOCCO, ROSINA
Entity Type:Individual
Prefix:
First Name:ROSINA
Middle Name:
Last Name:BELLOCCO
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 1:12 EATON RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6511
Mailing Address - Country:US
Mailing Address - Phone:516-330-8471
Mailing Address - Fax:
Practice Address - Street 1:151 PINE HOLLOW RD # CVS
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-4705
Practice Address - Country:US
Practice Address - Phone:516-922-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist