Provider Demographics
NPI:1376872291
Name:CROCCO, MICHAEL J (PHARMD, RPH, CSP)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:CROCCO
Suffix:
Gender:M
Credentials:PHARMD, RPH, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 DANIELS PKWY STE 19
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6900 DANIELS PKWY STE 19
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1586
Practice Address - Country:US
Practice Address - Phone:239-226-9707
Practice Address - Fax:239-226-1275
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2025-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43669183500000X
TX47085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist