MEDICARE: MR. JOHN VINCENT COCCHIARA R.PH., C.C.P.

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	28RI01899500	NJ
2	183500000X	Pharmacist	037858-1	NY

General Provider Information

NPI Number	:	1518962307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN VINCENT COCCHIARA R.PH., C.C.P.

Provider Business Mailing Address
First Line	:	21 COUNTRY CLUB LN
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-2221
Country	:	US
Telephone Number	:	732-761-8711
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 COUNTRY CLUB LN
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-2221
Country	:	US
Telephone Number	:	732-761-8711
Fax Number	:

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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