Provider Demographics
NPI:1376844092
Name:PICCOLO, DOUGLAS DAVID (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:DAVID
Last Name:PICCOLO
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 1:5727 BURKE CENTRE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2204
Mailing Address - Country:US
Mailing Address - Phone:703-323-8786
Mailing Address - Fax:703-239-9266
Practice Address - Street 1:5727 BURKE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2204
Practice Address - Country:US
Practice Address - Phone:703-323-8786
Practice Address - Fax:703-239-9266
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist