Healthcare Provider Details

I. General information

NPI: 1235808569
Provider Name (Legal Business Name): CARMELO LOPICCOLO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E KENNEDY BLVD
LAKEWOOD NJ
08701-1308
US

IV. Provider business mailing address

38 WOODHOLLOW DR
MANALAPAN NJ
07726-4658
US

V. Phone/Fax

Practice location:
  • Phone: 732-363-0880
  • Fax:
Mailing address:
  • Phone: 908-770-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02377000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: