Provider Demographics
NPI:1669563870
Name:SEVERINSKI, JOSEPH ROCCO (RPH)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ROCCO
Last Name:SEVERINSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:ROCCO
Other - Last Name:SEVERINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:205 W 20TH ST
Mailing Address - Street 2:LORAIN VA OUTPATIENT CLINIC
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3779
Mailing Address - Country:US
Mailing Address - Phone:440-244-3833
Mailing Address - Fax:440-244-3834
Practice Address - Street 1:205 W 20TH ST
Practice Address - Street 2:LORAIN VA OUTPATIENT CLINIC
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3779
Practice Address - Country:US
Practice Address - Phone:440-244-3833
Practice Address - Fax:440-244-3834
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-13472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist