Provider Demographics
NPI:1558655209
Name:BURACCHIO, JOHN L (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:BURACCHIO
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 1:897 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2704
Mailing Address - Country:US
Mailing Address - Phone:304-598-2534
Mailing Address - Fax:304-598-2540
Practice Address - Street 1:897 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2704
Practice Address - Country:US
Practice Address - Phone:304-598-2534
Practice Address - Fax:304-598-2540
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist