Provider Demographics
NPI:1750664942
Name:CANNIZZO, RICHARD ARTHUR JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ARTHUR
Last Name:CANNIZZO
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:4 CENTRAL SQUARE
Mailing Address - Street 2:WALGREENS PHARMACY
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324
Mailing Address - Country:US
Mailing Address - Phone:508-279-2980
Mailing Address - Fax:508-279-2986
Practice Address - Street 1:4 CENTRAL SQUARE
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324
Practice Address - Country:US
Practice Address - Phone:508-279-2980
Practice Address - Fax:508-279-2986
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPH23753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist