Provider Demographics
NPI:1467772087
Name:BIANCULLI, THOMAS J (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:BIANCULLI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10554 PERRY HWY RM 2
Mailing Address - Street 2:STORE
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9244
Mailing Address - Country:US
Mailing Address - Phone:724-935-4583
Mailing Address - Fax:724-934-3209
Practice Address - Street 1:10554 PERRY HWY RM 2
Practice Address - Street 2:STORE
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9244
Practice Address - Country:US
Practice Address - Phone:724-935-4583
Practice Address - Fax:724-934-3209
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARP025258L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist