Provider Demographics
NPI:1245897800
Name:CURCIO, PHILLIP ANDREW
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:ANDREW
Last Name:CURCIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:PEAK
Mailing Address - State:SC
Mailing Address - Zip Code:29122-0039
Mailing Address - Country:US
Mailing Address - Phone:803-345-1707
Mailing Address - Fax:
Practice Address - Street 1:22 RIVER STREET
Practice Address - Street 2:
Practice Address - City:PEAK
Practice Address - State:SC
Practice Address - Zip Code:29122
Practice Address - Country:US
Practice Address - Phone:803-345-1707
Practice Address - Fax:803-345-8952
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist