Healthcare Provider Details

I. General information

NPI: 1689235376
Provider Name (Legal Business Name): MARIO ZUCCAROLI PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 SPRING RD
SHERMANS DALE PA
17090-8539
US

IV. Provider business mailing address

5201 SPRING ROAD
SHERMANS DALE PA
17090
US

V. Phone/Fax

Practice location:
  • Phone: 717-582-7781
  • Fax:
Mailing address:
  • Phone: 717-582-7781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP444258
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: