Provider Demographics
NPI:1609649540
Name:DOLCIMASCOLO, PIETRO DOMENICO (PHARM D)
Entity Type:Individual
Prefix:
First Name:PIETRO
Middle Name:DOMENICO
Last Name:DOLCIMASCOLO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2178 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4725
Mailing Address - Country:US
Mailing Address - Phone:917-795-6614
Mailing Address - Fax:
Practice Address - Street 1:12704 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2955
Practice Address - Country:US
Practice Address - Phone:718-978-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist