Provider Demographics
NPI:1740594803
Name:DICRISCIO, ANTHONY MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:DICRISCIO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 MIFFLIN ST
Mailing Address - Street 2:
Mailing Address - City:SAXTON
Mailing Address - State:PA
Mailing Address - Zip Code:16678-1125
Mailing Address - Country:US
Mailing Address - Phone:814-386-2145
Mailing Address - Fax:
Practice Address - Street 1:905 MIFFLIN ST
Practice Address - Street 2:
Practice Address - City:SAXTON
Practice Address - State:PA
Practice Address - Zip Code:16678-1125
Practice Address - Country:US
Practice Address - Phone:814-386-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-01
Last Update Date:2010-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP444593OtherLICENSE