Provider Demographics
NPI:1760701015
Name:COCCIA, ERNEST NICHOLAS (RPH)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:NICHOLAS
Last Name:COCCIA
Suffix:
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 1:2913 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-4947
Mailing Address - Country:US
Mailing Address - Phone:267-273-0620
Mailing Address - Fax:215-334-5046
Practice Address - Street 1:800 W MOYAMENSING AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3709
Practice Address - Country:US
Practice Address - Phone:215-334-1833
Practice Address - Fax:215-334-5046
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-032264L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008659020003Medicaid