Healthcare Provider Details

I. General information

NPI: 1043587355
Provider Name (Legal Business Name): CAROLYN CATHERINE CUCINOTTA R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 NUTT RD
PHOENIXVILLE PA
19460-3354
US

IV. Provider business mailing address

144 KIMBERBRAE DR
PHOENIXVILLE PA
19460-1615
US

V. Phone/Fax

Practice location:
  • Phone: 610-933-2798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP041853L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: