Provider Demographics
NPI:1912015611
Name:CROCE, JOHN L (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:CROCE
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 1:360 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1904
Mailing Address - Country:US
Mailing Address - Phone:518-439-8200
Mailing Address - Fax:518-439-3657
Practice Address - Street 1:360 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1904
Practice Address - Country:US
Practice Address - Phone:518-439-8200
Practice Address - Fax:518-439-3657
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist