Provider Demographics
NPI:1376838052
Name:VERTUCCIO, TRICIA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:TRICIA ANN
Middle Name:
Last Name:VERTUCCIO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HULL RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483
Mailing Address - Country:US
Mailing Address - Phone:203-305-1502
Mailing Address - Fax:
Practice Address - Street 1:20 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1812
Practice Address - Country:US
Practice Address - Phone:203-278-5056
Practice Address - Fax:203-278-5056
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0008791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist