Provider Demographics
NPI:1285953778
Name:DICICCO, JOSEPHINE ANNE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:ANNE
Last Name:DICICCO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 RAVENSWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3417
Mailing Address - Country:US
Mailing Address - Phone:856-415-2381
Mailing Address - Fax:856-415-2381
Practice Address - Street 1:675 WOODBURY GLASSBORO RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3733
Practice Address - Country:US
Practice Address - Phone:856-415-2381
Practice Address - Fax:856-415-2381
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-23
Last Update Date:2010-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02702200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02702200OtherPHARMACY LICENSE NUMBER