Provider Demographics
NPI:1396028478
Name:PICCIRILLO, GAETANO B JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GAETANO
Middle Name:B
Last Name:PICCIRILLO
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 CENTERVILLE RD
Mailing Address - Street 2:SUITE# 106
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4354
Mailing Address - Country:US
Mailing Address - Phone:401-739-1732
Mailing Address - Fax:
Practice Address - Street 1:469 CENTERVILLE RD
Practice Address - Street 2:SUITE# 106
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4354
Practice Address - Country:US
Practice Address - Phone:401-739-1732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist