Provider Demographics
NPI:1811229149
Name:RICCHIUTI, ANTHONY B (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:B
Last Name:RICCHIUTI
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 1:6434 CROMWELL CRES
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5021
Mailing Address - Country:US
Mailing Address - Phone:917-597-4226
Mailing Address - Fax:718-275-3799
Practice Address - Street 1:6434 CROMWELL CRES
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5021
Practice Address - Country:US
Practice Address - Phone:917-597-4226
Practice Address - Fax:718-275-3799
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist