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General NPI Number Information
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NPI Number | 1952429284
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Entity Type | Individual
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Provider Name | CHARLES ANTHONY CIACCIO RPH
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 6459 DRY HARBOR RD
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-2392
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Country | US
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Telephone | 718-806-1455
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Fax | 718-806-1151
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Provider Business Mailing Address
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Address Line | 64-59 DRY HARBOR RD
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City | QUEENS
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State | NY
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Zip | 11379-1853
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Country | US
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Telephone | 718-806-1455
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Fax | 718-806-1151
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 042144
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License Number State | NY
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