Provider Demographics
NPI:1083038285
Name:GIACOBELLO, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GIACOBELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SANDHILL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5806
Mailing Address - Country:US
Mailing Address - Phone:302-376-9355
Mailing Address - Fax:302-376-9388
Practice Address - Street 1:118 SANDHILL DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5806
Practice Address - Country:US
Practice Address - Phone:302-376-9355
Practice Address - Fax:302-376-9388
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-00002847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist