Provider Demographics
NPI:1659576775
Name:LICCARDI, PETER (PETER LICCARDI)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:LICCARDI
Suffix:
Gender:M
Credentials:PETER LICCARDI
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:LICCARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PETER LICCARDI
Mailing Address - Street 1:55 JAFFARIAN RD
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-1407
Mailing Address - Country:US
Mailing Address - Phone:978-372-2545
Mailing Address - Fax:
Practice Address - Street 1:11 HAVERHILL RD
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-3521
Practice Address - Country:US
Practice Address - Phone:978-834-0014
Practice Address - Fax:978-834-9820
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist