Provider Demographics
NPI:1588262265
Name:IACONO, CHRISTOPHER (PHARM D, RPH)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:IACONO
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 TRENTON AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08007-1061
Mailing Address - Country:US
Mailing Address - Phone:856-813-0410
Mailing Address - Fax:
Practice Address - Street 1:5040 CITY LINE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1435
Practice Address - Country:US
Practice Address - Phone:215-877-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP455127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist