Provider Demographics
NPI:1427658251
Name:HUPP PERCOCO, VICKY SUE (RPH)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:SUE
Last Name:HUPP PERCOCO
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 1:4923 ALAVISTA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4763
Mailing Address - Country:US
Mailing Address - Phone:740-973-7552
Mailing Address - Fax:
Practice Address - Street 1:1471 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1604
Practice Address - Country:US
Practice Address - Phone:407-870-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist