Provider Demographics
NPI:1477540029
Name:MACIOCI, RAYMOND (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:MACIOCI
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 1:136 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-1733
Mailing Address - Country:US
Mailing Address - Phone:914-395-1851
Mailing Address - Fax:718-828-7491
Practice Address - Street 1:2941 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4534
Practice Address - Country:US
Practice Address - Phone:718-828-0498
Practice Address - Fax:718-828-7491
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist