MEDICARE: MR. ANTONIO MARIO SELLECCHIA JR.

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	RP045337L	PA

General Provider Information

NPI Number	:	1619958394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTONIO MARIO SELLECCHIA JR.

Provider Business Mailing Address
First Line	:	7100 TORRESDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-1313
Country	:	US
Telephone Number	:	215-624-0919
Fax Number	:	215-624-0920

Provider Business Practice Location Address
First Line	:	7100 TORRESDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-1313
Country	:	US
Telephone Number	:	215-624-0919
Fax Number	:	215-624-0920

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/08/2007

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