Provider Demographics
NPI:1417277377
Name:TROCCIA, CHAD (RPH)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:TROCCIA
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 1:129 PAMPAS DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4031
Mailing Address - Country:US
Mailing Address - Phone:912-704-8679
Mailing Address - Fax:
Practice Address - Street 1:129 PAMPAS DR
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4031
Practice Address - Country:US
Practice Address - Phone:912-704-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048911183500000X
GA021970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist