Provider Demographics
NPI:1295371318
Name:ACCIAIOLI, JOSEPH LYLE (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LYLE
Last Name:ACCIAIOLI
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 1:8785 RIVER RUN DR
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-4610
Mailing Address - Country:US
Mailing Address - Phone:248-891-2344
Mailing Address - Fax:
Practice Address - Street 1:5111 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1915
Practice Address - Country:US
Practice Address - Phone:248-673-4324
Practice Address - Fax:248-673-7318
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist