Provider Demographics
NPI:1417657149
Name:BRICCA, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BRICCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 46TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-1920
Mailing Address - Country:US
Mailing Address - Phone:516-480-7656
Mailing Address - Fax:
Practice Address - Street 1:600 WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2000
Practice Address - Country:US
Practice Address - Phone:631-226-1805
Practice Address - Fax:631-956-0332
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician