Provider Demographics
NPI:1487254066
Name:D'URSO, ANTHONY FRANK
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FRANK
Last Name:D'URSO
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 1:44 APPLE LN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:PA
Mailing Address - Zip Code:16329-3002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2901 MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-5216
Practice Address - Country:US
Practice Address - Phone:814-723-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP450956OtherPHARMACIST LICENSE NUMBER