Provider Demographics
NPI:1962617324
Name:CIRILLO, JEANNE MARIE (RPH)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:CIRILLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:CIRILLO-MARCUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1646 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2218
Mailing Address - Country:US
Mailing Address - Phone:718-477-0357
Mailing Address - Fax:
Practice Address - Street 1:1646 E 8TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2218
Practice Address - Country:US
Practice Address - Phone:718-477-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist