MEDICARE: JOSEPH TABACCHI

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	03212582	OH

General Provider Information

NPI Number	:	1942708953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH TABACCHI

Provider Business Mailing Address
First Line	:	50198 W RUSTIC DR APT 32
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-9140
Country	:	US
Telephone Number	:	740-310-2074
Fax Number	:	740-695-7169

Provider Business Practice Location Address
First Line	:	50789 VALLEY PLAZA DR
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-1752
Country	:	US
Telephone Number	:	740-695-7170
Fax Number	:	740-695-7169

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

Provider Enumeration Date	:	01/24/2018
Last Update Date	:	01/24/2018

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