Provider Demographics
NPI:1861006462
Name:CONCA, ADDISON (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADDISON
Middle Name:
Last Name:CONCA
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 1:29 BROWNELL ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-1501
Mailing Address - Country:US
Mailing Address - Phone:845-401-0852
Mailing Address - Fax:
Practice Address - Street 1:1737 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02746-2128
Practice Address - Country:US
Practice Address - Phone:508-984-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05275183500000X
MAPH234915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist