Provider Demographics
NPI:1922449511
Name:CUCCI, MICHAEL SIMON (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SIMON
Last Name:CUCCI
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:MICHAEL S.
Other - Middle Name:
Other - Last Name:CUCCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:2947 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4322
Mailing Address - Country:US
Mailing Address - Phone:516-641-7046
Mailing Address - Fax:
Practice Address - Street 1:50 ROUTE 25A
Practice Address - Street 2:ST CATHERINE OF SIENA MEDICAL CENTER - DEPT OF PHARMACY
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1348
Practice Address - Country:US
Practice Address - Phone:631-862-3020
Practice Address - Fax:631-862-3732
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI0580901835P0018X
NY0580901835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY058090OtherNYS BOARD OF PHARMACY LICENSURE (PHARMACIST)
NYI058090OtherNYS BOARD OF PHARMACY LICENSURE (PHARMACIST)