Provider Demographics
NPI:1619145604
Name:PICCOLINO, CAMILLE MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:MARIE
Last Name:PICCOLINO
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 1:35 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8011
Mailing Address - Country:US
Mailing Address - Phone:203-748-9122
Mailing Address - Fax:203-748-9135
Practice Address - Street 1:35 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-8011
Practice Address - Country:US
Practice Address - Phone:203-748-9122
Practice Address - Fax:203-748-9135
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0008645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist