Provider Demographics
NPI:1366537714
Name:GIOVANNUCCI, MICHELLE SOPHIA (RPH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SOPHIA
Last Name:GIOVANNUCCI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 DELLETT COURT
Mailing Address - Street 2:
Mailing Address - City:SHAMONG
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-9511
Mailing Address - Country:US
Mailing Address - Phone:908-347-8411
Mailing Address - Fax:609-268-7164
Practice Address - Street 1:3031 RED LION RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1123
Practice Address - Country:US
Practice Address - Phone:215-347-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02175700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist