Healthcare Provider Details

I. General information

NPI: 1346522745
Provider Name (Legal Business Name): STEPHEN R AUCELLO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 E HOBSON WAY
BLYTHE CA
92225-1800
US

IV. Provider business mailing address

1017 N CROFT #2
LOS ANGELES CA
90069
US

V. Phone/Fax

Practice location:
  • Phone: 760-922-9867
  • Fax:
Mailing address:
  • Phone: 562-221-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: