=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811275811
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. AMY ELIZABETH RICCIO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2011
-----------------------------------------------------
Last Update Date | 05/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 SUNNYBROOK RD RM 107
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27610-1861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-250-4418
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 SUNNYBROOK RD RM 107
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27610-1808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-250-4418
-----------------------------------------------------
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 | 21823
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------