MEDICARE: RALPH MOCCIOLA

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	7401	CT

General Provider Information

NPI Number	:	1447604129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH MOCCIOLA

Provider Business Mailing Address
First Line	:	1968 BLACK ROCK TPKE
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06825-3543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 BLACK ROCK TPKE
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06825-3543
Country	:	US
Telephone Number	:	203-366-8070
Fax Number	:	203-335-2132

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

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	04/19/2016

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Directions to “ RALPH MOCCIOLA ” Practice Location

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