Healthcare Provider Details

I. General information

NPI: 1922449511
Provider Name (Legal Business Name): MICHAEL SIMON CUCCI PHARM.D., RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL S. CUCCI PHARM.D., RPH

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ROUTE 25A ST CATHERINE OF SIENA MEDICAL CENTER - DEPT OF PHARMACY
SMITHTOWN NY
11787-1348
US

IV. Provider business mailing address

2947 BAYVIEW AVE
WANTAGH NY
11793-4322
US

V. Phone/Fax

Practice location:
  • Phone: 631-862-3020
  • Fax: 631-862-3732
Mailing address:
  • Phone: 516-641-7046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberI058090
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number058090
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: