Healthcare Provider Details

I. General information

NPI: 1386671733
Provider Name (Legal Business Name): DR. FRANK PUCINO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W MAIN ST
NEW MARKET MD
21774-6237
US

IV. Provider business mailing address

135 W MAIN ST
NEW MARKET MD
21774-6237
US

V. Phone/Fax

Practice location:
  • Phone: 301-831-3764
  • Fax:
Mailing address:
  • Phone: 301-831-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2635
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: