Provider Demographics
NPI:1124209374
Name:CHIRICO, GERARD M (RPH)
Entity type:Individual
Prefix:MR
First Name:GERARD
Middle Name:M
Last Name:CHIRICO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3550
Mailing Address - Country:US
Mailing Address - Phone:718-317-8332
Mailing Address - Fax:718-227-1360
Practice Address - Street 1:320 SMITH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4608
Practice Address - Country:US
Practice Address - Phone:718-403-9371
Practice Address - Fax:718-403-9376
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist