Healthcare Provider Details

I. General information

NPI: 1033708979
Provider Name (Legal Business Name): THERESA CUCCIA-DILLARD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 FISH HATCHERY RD
MADISON WI
53713-1238
US

IV. Provider business mailing address

PO BOX 259686
MADISON WI
53725-9686
US

V. Phone/Fax

Practice location:
  • Phone: 608-268-0355
  • Fax:
Mailing address:
  • Phone: 608-268-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9183-42
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: