Provider Demographics
NPI:1588759187
Name:LOIACONO, JOSEPH A (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:LOIACONO
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 1:63 LIBERTY STREET
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644
Mailing Address - Country:US
Mailing Address - Phone:973-773-8380
Mailing Address - Fax:
Practice Address - Street 1:73 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1715
Practice Address - Country:US
Practice Address - Phone:973-821-5414
Practice Address - Fax:973-275-5220
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01503300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist