Provider Demographics
NPI:1194877217
Name:BROCCO, IRIS V
Entity type:Individual
Prefix:MS
First Name:IRIS
Middle Name:V
Last Name:BROCCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LEXINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3849
Mailing Address - Country:US
Mailing Address - Phone:856-983-5552
Mailing Address - Fax:
Practice Address - Street 1:1005 SUNSET RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-2251
Practice Address - Country:US
Practice Address - Phone:609-386-3630
Practice Address - Fax:609-386-0134
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01572600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist