Provider Demographics
NPI:1114181690
Name:CIACCIO, ZOBEIDA AZUCENA (RPH)
Entity type:Individual
Prefix:MRS
First Name:ZOBEIDA
Middle Name:AZUCENA
Last Name:CIACCIO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1303
Mailing Address - Country:US
Mailing Address - Phone:516-731-9692
Mailing Address - Fax:516-731-9692
Practice Address - Street 1:3850 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1303
Practice Address - Country:US
Practice Address - Phone:516-731-9692
Practice Address - Fax:516-731-9692
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046411-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02783200Medicaid