MEDICARE: MR. JOHN ANTHONY PETRACCI R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03316874	OH
2	183500000X	Pharmacist	PS23764	FL

General Provider Information

NPI Number	:	1013906361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ANTHONY PETRACCI R.PH

Provider Business Mailing Address
First Line	:	602 PARMALEE AVE
Second Line	:	SUITE 100
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44510-1653
Country	:	US
Telephone Number	:	330-746-2657
Fax Number	:	330-746-0014

Provider Business Practice Location Address
First Line	:	602 PARMALEE AVE
Second Line	:	SUITE 100
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44510-1653
Country	:	US
Telephone Number	:	330-746-2657
Fax Number	:	330-746-0014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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