Healthcare Provider Details

I. General information

NPI: 1992043434
Provider Name (Legal Business Name): ANTHONY CIORCIARI R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 BROADWAY
GRAND JUNCTION CO
81507-2758
US

IV. Provider business mailing address

2512 BROADWAY
GRAND JUNCTION CO
81507-2758
US

V. Phone/Fax

Practice location:
  • Phone: 970-257-0233
  • Fax:
Mailing address:
  • Phone: 970-257-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15398
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: