Provider Demographics
NPI:1386352904
Name:PIERONI, MICHAEL EDWARD
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:PIERONI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 MILANO AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-2127
Mailing Address - Country:US
Mailing Address - Phone:617-650-4203
Mailing Address - Fax:
Practice Address - Street 1:339 SQUIRE RD
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-6148
Practice Address - Country:US
Practice Address - Phone:781-289-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist