=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245517036
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY JOHN CIOCE SR. RP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2011
-----------------------------------------------------
Last Update Date | 11/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 377 VALLEY RD
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07013-1319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-278-8876
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 EUGENE DR
-----------------------------------------------------
City | MONTVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07045-9192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-257-0334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI01236000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------