Provider Demographics
NPI:1326363243
Name:MAFFUCCI, JOHN P (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:MAFFUCCI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-6064
Mailing Address - Country:US
Mailing Address - Phone:845-225-4242
Mailing Address - Fax:
Practice Address - Street 1:511 ROUTE 52
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-6064
Practice Address - Country:US
Practice Address - Phone:845-225-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-03
Last Update Date:2010-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034821OtherNYS HEALTH DEPARTMENT