Provider Demographics
NPI:1578871190
Name:BACCI, AUDREY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:
Last Name:BACCI
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 1:2 CROSSWICKS RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3009
Mailing Address - Country:US
Mailing Address - Phone:732-577-6533
Mailing Address - Fax:
Practice Address - Street 1:3120 ROUTE 35
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1520
Practice Address - Country:US
Practice Address - Phone:732-739-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R102863100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist