Provider Demographics
NPI:1710056866
Name:FUCARINO, DAN DOMINIC (BPHARM)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:DOMINIC
Last Name:FUCARINO
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11775 N. DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3503
Mailing Address - Country:US
Mailing Address - Phone:813-961-8798
Mailing Address - Fax:813-962-0092
Practice Address - Street 1:11775 N. DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3503
Practice Address - Country:US
Practice Address - Phone:813-961-8798
Practice Address - Fax:813-962-0092
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist