Provider Demographics
NPI:1801154745
Name:CONVILLE PICINICH, JUDY (RPH)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:CONVILLE PICINICH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 YORKTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3561
Mailing Address - Country:US
Mailing Address - Phone:732-792-7606
Mailing Address - Fax:732-792-7606
Practice Address - Street 1:26 YORKTOWNE DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3561
Practice Address - Country:US
Practice Address - Phone:732-792-7606
Practice Address - Fax:732-792-7606
Is Sole Proprietor?:No
Enumeration Date:2012-04-29
Last Update Date:2012-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01933400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist