Provider Demographics
NPI:1629888177
Name:RICCITELLI, ROCCO STEVEN
Entity type:Individual
Prefix:
First Name:ROCCO
Middle Name:STEVEN
Last Name:RICCITELLI
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 1:55 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:RI
Mailing Address - Zip Code:02831-1354
Mailing Address - Country:US
Mailing Address - Phone:401-525-8882
Mailing Address - Fax:
Practice Address - Street 1:763 TIOGUE AVE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-5805
Practice Address - Country:US
Practice Address - Phone:401-821-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH06699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist