Provider Demographics
NPI:1265707145
Name:BOCCIERI, MICHAEL CLAWSON (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CLAWSON
Last Name:BOCCIERI
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 1:10401 RESEARCH BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5712
Mailing Address - Country:US
Mailing Address - Phone:512-634-2252
Mailing Address - Fax:512-364-2271
Practice Address - Street 1:10401 RESEARCH BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5712
Practice Address - Country:US
Practice Address - Phone:512-634-2252
Practice Address - Fax:512-364-2271
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist