Provider Demographics
NPI:1518279769
Name:PUCCIO, GEORGE W (RPH)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:W
Last Name:PUCCIO
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 1:16 SOFTWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-6791
Mailing Address - Country:US
Mailing Address - Phone:908-607-0017
Mailing Address - Fax:
Practice Address - Street 1:132 N GASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2419
Practice Address - Country:US
Practice Address - Phone:908-722-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-04
Last Update Date:2010-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01863400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist