Healthcare Provider Details

I. General information

NPI: 1124203120
Provider Name (Legal Business Name): ANDREW J LOCCISANO CONSULTANT R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 NE 39TH ST
OCALA FL
34479-8640
US

IV. Provider business mailing address

1727 NE 39TH ST
OCALA FL
34479-8640
US

V. Phone/Fax

Practice location:
  • Phone: 352-362-2000
  • Fax: 352-622-1936
Mailing address:
  • Phone: 352-362-2000
  • Fax: 352-622-1936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPU4429
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPU4429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: