MEDICARE: JAMES CIRILLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP041547L	PA

General Provider Information

NPI Number	:	1619638160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES CIRILLO

Provider Business Mailing Address
First Line	:	37 WELLINGTON RD
Second Line	:
City	:	NEWTOWN
State	:	PA
Zip	:	18940-2413
Country	:	US
Telephone Number	:	160-956-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	2923 E THOMPSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4812
Country	:	US
Telephone Number	:	215-739-0548
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2022
Last Update Date	:	01/06/2022

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