Provider Demographics
NPI:1467028571
Name:RICCIO, CARMINO M (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARMINO
Middle Name:M
Last Name:RICCIO
Suffix:
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 1:171 SCITUATE AVE
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:RI
Mailing Address - Zip Code:02831-1899
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4047
Practice Address - Country:US
Practice Address - Phone:401-942-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-29
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH06166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist