Provider Demographics
NPI:1689279663
Name:CUTILLO, JOSEPH JR
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:CUTILLO
Suffix:JR
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 1:2320 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2519
Mailing Address - Country:US
Mailing Address - Phone:215-232-5262
Mailing Address - Fax:215-232-5149
Practice Address - Street 1:2320 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2519
Practice Address - Country:US
Practice Address - Phone:215-232-5262
Practice Address - Fax:215-232-5149
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450030L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist