Provider Demographics
NPI:1740400175
Name:PIERCE, JOHN C I
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:PIERCE
Suffix:I
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 1:183 ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3708
Mailing Address - Country:US
Mailing Address - Phone:508-833-8819
Mailing Address - Fax:508-833-2756
Practice Address - Street 1:2260 STATE RD
Practice Address - Street 2:OSCO #7585
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-5177
Practice Address - Country:US
Practice Address - Phone:508-833-8819
Practice Address - Fax:508-833-2756
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18586183500000X
RI2881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist