Provider Demographics
NPI:1629639307
Name:TENAGLIA, ROCKY
Entity Type:Individual
Prefix:
First Name:ROCKY
Middle Name:
Last Name:TENAGLIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 NANTASKET AVE
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-2544
Mailing Address - Country:US
Mailing Address - Phone:781-925-1270
Mailing Address - Fax:781-925-0551
Practice Address - Street 1:480 NANTASKET AVE
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045-2544
Practice Address - Country:US
Practice Address - Phone:781-925-1270
Practice Address - Fax:781-925-0551
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist