Provider Demographics
NPI:1497030191
Name:BUCCO, LISA (RPH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BUCCO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1345
Mailing Address - Country:US
Mailing Address - Phone:201-444-2754
Mailing Address - Fax:201-497-5691
Practice Address - Street 1:72 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1345
Practice Address - Country:US
Practice Address - Phone:201-444-2754
Practice Address - Fax:201-497-5691
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02885900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist