Provider Demographics
NPI:1639527849
Name:IANNUCCI, ANNETTE (RAH)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:
Last Name:IANNUCCI
Suffix:
Gender:F
Credentials:RAH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 JIMS TRL
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1556
Mailing Address - Country:US
Mailing Address - Phone:914-441-1009
Mailing Address - Fax:914-245-8972
Practice Address - Street 1:89 JIMS TRL
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1556
Practice Address - Country:US
Practice Address - Phone:914-441-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH242942183500000X
FLPS 30424183500000X
CT0008831183500000X
NY043432-1183500000X
NC14044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist