Provider Demographics
NPI:1689235376
Name:ZUCCAROLI, MARIO (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:ZUCCAROLI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 SPRING ROAD
Mailing Address - Street 2:
Mailing Address - City:SHERMANS DALE
Mailing Address - State:PA
Mailing Address - Zip Code:17090
Mailing Address - Country:US
Mailing Address - Phone:717-582-7781
Mailing Address - Fax:
Practice Address - Street 1:5201 SPRING RD
Practice Address - Street 2:
Practice Address - City:SHERMANS DALE
Practice Address - State:PA
Practice Address - Zip Code:17090-8539
Practice Address - Country:US
Practice Address - Phone:717-582-7781
Practice Address - Fax:
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
PARP444258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist