Provider Demographics
NPI:1679127336
Name:COCCO, ANDREW JOSEPH
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:COCCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6329
Mailing Address - Country:US
Mailing Address - Phone:484-442-8878
Mailing Address - Fax:
Practice Address - Street 1:644 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-2525
Practice Address - Country:US
Practice Address - Phone:610-964-8981
Practice Address - Fax:610-964-1624
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030550L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist