Individual
DAVID DEICICCHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
41 AVENUE LOUIS PASTEUR STE 216, BOSTON, MA 02115-5727
(617) 264-5872
Mailing address
1250 HANCOCK ST, QUINCY, MA 02169-4339
(617) 264-5872
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
PH232796
MA
1835P2201X
Ambulatory Care Pharmacist
Primary
PH232796
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD1123277P
MCSR
MA
Enumeration date
02/03/2012
Last updated
12/26/2018
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