Provider Demographics
NPI:1710938717
Name:OCCHINO, PHILIP J JR (RPH)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:OCCHINO
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12558 WARNER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WALES
Mailing Address - State:NY
Mailing Address - Zip Code:14139-9742
Mailing Address - Country:US
Mailing Address - Phone:716-523-8118
Mailing Address - Fax:
Practice Address - Street 1:3242 ROUTE 39
Practice Address - Street 2:
Practice Address - City:YORKSHIRE
Practice Address - State:NY
Practice Address - Zip Code:14173
Practice Address - Country:US
Practice Address - Phone:716-492-0176
Practice Address - Fax:716-492-5377
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-14
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist