MEDICARE: MR. DAVID PAUL ACCONCIA RPH

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	03-2-12574	OH

General Provider Information

NPI Number	:	1760475479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID PAUL ACCONCIA RPH

Provider Business Mailing Address
First Line	:	111 JACOBS DR
Second Line	:
City	:	WAPAKONETA
State	:	OH
Zip	:	45895-1358
Country	:	US
Telephone Number	:	419-738-8612
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 E PIKE ST
Second Line	:
City	:	JACKSON CENTER
State	:	OH
Zip	:	45334-6000
Country	:	US
Telephone Number	:	937-596-6621
Fax Number	:	937-596-6637

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/08/2007

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