Healthcare Provider Details

I. General information

NPI: 1457085219
Provider Name (Legal Business Name): ANTONIETTA PANECCASIO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

4340 N MIAMI DR
PARMA OH
44134-6218
US

V. Phone/Fax

Practice location:
  • Phone: 440-781-3936
  • Fax:
Mailing address:
  • Phone: 440-781-3936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number03441132
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: