Provider Demographics
NPI:1679881189
Name:BRANCACCIO, ABBY MARIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ABBY
Middle Name:MARIE
Last Name:BRANCACCIO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:ABBY
Other - Middle Name:MARIE
Other - Last Name:HUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15090 IDLEWILD RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104
Mailing Address - Country:US
Mailing Address - Phone:704-882-4051
Mailing Address - Fax:704-882-0390
Practice Address - Street 1:15090 IDLEWILD RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-3653
Practice Address - Country:US
Practice Address - Phone:704-882-4051
Practice Address - Fax:704-882-0390
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist