Provider Demographics
NPI:1407030414
Name:MENNUCCI, MARCO D (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:D
Last Name:MENNUCCI
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 1:4456 FEDERAL ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14487
Mailing Address - Country:US
Mailing Address - Phone:585-442-2118
Mailing Address - Fax:
Practice Address - Street 1:4287 GENESEE VALLEY PLZ
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-9434
Practice Address - Country:US
Practice Address - Phone:585-243-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY049717OtherPHARMACIST LICENSE NUMBER