Provider Demographics
NPI:1225356280
Name:GIAMBANCO, MARK
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:GIAMBANCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-2700
Mailing Address - Country:US
Mailing Address - Phone:508-238-6929
Mailing Address - Fax:508-238-6463
Practice Address - Street 1:690 DEPOT ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-2700
Practice Address - Country:US
Practice Address - Phone:508-238-6929
Practice Address - Fax:508-238-6463
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist