Provider Demographics
NPI:1699065086
Name:SCHILLACI, LEO JOSEPH (RPH)
Entity type:Individual
Prefix:MR
First Name:LEO
Middle Name:JOSEPH
Last Name:SCHILLACI
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 1:838 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3388
Mailing Address - Country:US
Mailing Address - Phone:336-996-6075
Mailing Address - Fax:
Practice Address - Street 1:838 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3388
Practice Address - Country:US
Practice Address - Phone:336-996-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12776183500000X
LAPST.009135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist