MEDICARE: ANTHONY PAUL MICOLUCCI 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	19929	FL

General Provider Information

NPI Number	:	1841913555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY PAUL MICOLUCCI RPH

Provider Business Mailing Address
First Line	:	2818 MADRID ST
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6066
Country	:	US
Telephone Number	:	904-945-0065
Fax Number	:

Provider Business Practice Location Address
First Line	:	2818 MADRID ST
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6066
Country	:	US
Telephone Number	:	904-945-0065
Fax Number	:

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

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	09/19/2022

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