Provider Demographics
NPI:1205016540
Name:ZECCA, ROBERT L (BS,RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:ZECCA
Suffix:
Gender:M
Credentials:BS,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2743
Mailing Address - Country:US
Mailing Address - Phone:845-340-0664
Mailing Address - Fax:845-339-4095
Practice Address - Street 1:351 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2743
Practice Address - Country:US
Practice Address - Phone:845-340-0664
Practice Address - Fax:845-339-4095
Is Sole Proprietor?:No
Enumeration Date:2007-11-03
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist