Provider Demographics
NPI:1588857478
Name:LAURICELLA, JOSEPH C (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:C
Last Name:LAURICELLA
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 1:1101 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-2616
Mailing Address - Country:US
Mailing Address - Phone:570-454-9608
Mailing Address - Fax:570-454-5252
Practice Address - Street 1:1101 W 15TH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-2616
Practice Address - Country:US
Practice Address - Phone:570-454-9608
Practice Address - Fax:570-454-5252
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2013-12-19
Deactivation Date:2011-03-24
Deactivation Code:
Reactivation Date:2013-12-19
Provider Licenses
StateLicense IDTaxonomies
PARP1000705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA113695Medicare PIN