Provider Demographics
NPI:1316070394
Name:PIEKOS, JOSEPH ALLEN (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALLEN
Last Name:PIEKOS
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 1:19 ALTO DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3759
Mailing Address - Country:US
Mailing Address - Phone:781-391-6689
Mailing Address - Fax:617-628-1564
Practice Address - Street 1:299 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1933
Practice Address - Country:US
Practice Address - Phone:617-628-1014
Practice Address - Fax:617-628-1564
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist