Provider Demographics
NPI:1366010522
Name:GUCCIONE, DANA BRIANNE (PHARMACY INTERN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:BRIANNE
Last Name:GUCCIONE
Suffix:
Gender:F
Credentials:PHARMACY INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 HAWLEY ST APT 5
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-4051
Mailing Address - Country:US
Mailing Address - Phone:914-806-7936
Mailing Address - Fax:
Practice Address - Street 1:WEIS MARKETS
Practice Address - Street 2:160 ROBINSON ST.
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901
Practice Address - Country:US
Practice Address - Phone:607-762-5409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101697390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101697OtherPHARMACY INTERN LICENSE