Healthcare Provider Details

I. General information

NPI: 1841575610
Provider Name (Legal Business Name): CHRISTINA BOCCO PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 EAST BROAD STREET
BRIDGETON NJ
08302-2831
US

IV. Provider business mailing address

13 SAINT ANDREWS DRIVE
LAUREL SPRINGS NJ
08021
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-0777
  • Fax:
Mailing address:
  • Phone: 856-227-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03441200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: