Provider Demographics
NPI:1427172410
Name:CIROCCO, COSMO J (RPH)
Entity type:Individual
Prefix:
First Name:COSMO
Middle Name:J
Last Name:CIROCCO
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 1:810 PAUL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4421
Mailing Address - Country:US
Mailing Address - Phone:585-426-0820
Mailing Address - Fax:585-426-2158
Practice Address - Street 1:6081 VICTOR MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-1062
Practice Address - Country:US
Practice Address - Phone:585-742-1910
Practice Address - Fax:585-742-1921
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist