Provider Demographics
NPI:1699097626
Name:MUCITELLI, ANDREA D (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:D
Last Name:MUCITELLI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:830 CONSUMER SQUARE PLAZA ROUTE 64
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14903
Mailing Address - Country:US
Mailing Address - Phone:607-739-0495
Mailing Address - Fax:855-331-9208
Practice Address - Street 1:830 CONSUMER SQUARE PLAZA, RT 64
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14903
Practice Address - Country:US
Practice Address - Phone:607-739-0495
Practice Address - Fax:855-331-9208
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist