MEDICARE: MR. JOSEPH PROCOPIO 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	28RI03699700	NJ

General Provider Information

NPI Number	:	1275086241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH PROCOPIO R. PH

Provider Business Mailing Address
First Line	:	532 JACKSON AVENUE
Second Line	:
City	:	RAHWAY
State	:	NJ
Zip	:	07065
Country	:	US
Telephone Number	:	732-221-0848
Fax Number	:

Provider Business Practice Location Address
First Line	:	532 JACKSON AVE
Second Line	:
City	:	RAHWAY
State	:	NJ
Zip	:	07065-3514
Country	:	US
Telephone Number	:	732-221-0848
Fax Number	:

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

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	07/26/2016

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