Healthcare Provider Details

I. General information

NPI: 1093319436
Provider Name (Legal Business Name): DR. ANTHONY ERNEST ANGELUCCI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 MILES RD
WEST CHESTER PA
19380-1950
US

IV. Provider business mailing address

1402 MANTEL DR
WEST CHESTER PA
19382-5203
US

V. Phone/Fax

Practice location:
  • Phone: 610-429-3477
  • Fax: 610-696-7399
Mailing address:
  • Phone: 610-563-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP444795
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: