Provider Demographics
NPI:1770765042
Name:LOCICERO, GABRIELLA M (RPH)
Entity type:Individual
Prefix:MRS
First Name:GABRIELLA
Middle Name:M
Last Name:LOCICERO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:GABRIELLA
Other - Middle Name:M
Other - Last Name:LOMONACO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:9 LORETTA DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5818
Mailing Address - Country:US
Mailing Address - Phone:516-677-0321
Mailing Address - Fax:
Practice Address - Street 1:198 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5512
Practice Address - Country:US
Practice Address - Phone:516-561-1873
Practice Address - Fax:516-561-1428
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0396051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00397035Medicaid