Provider Demographics
NPI:1215485065
Name:FUSELLI, JOSEPH (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:FUSELLI
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 1:708 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-1019
Mailing Address - Country:US
Mailing Address - Phone:610-721-5861
Mailing Address - Fax:
Practice Address - Street 1:708 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-1019
Practice Address - Country:US
Practice Address - Phone:610-721-5861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032317L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist