Provider Demographics
NPI:1124203120
Name:LOCCISANO, ANDREW J (CONSULTANT RPH)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:LOCCISANO
Suffix:
Gender:M
Credentials:CONSULTANT RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 NE 39TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34479-8640
Mailing Address - Country:US
Mailing Address - Phone:352-362-2000
Mailing Address - Fax:352-622-1936
Practice Address - Street 1:1727 NE 39TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34479-8640
Practice Address - Country:US
Practice Address - Phone:352-362-2000
Practice Address - Fax:352-622-1936
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU4429174400000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No174400000XOther Service ProvidersSpecialist