Provider Demographics
NPI:1245513084
Name:SERVIZIO, ANNALISA L (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANNALISA
Middle Name:L
Last Name:SERVIZIO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ELLIOT STREET
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-921-0506
Mailing Address - Fax:978-921-0129
Practice Address - Street 1:54 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3359
Practice Address - Country:US
Practice Address - Phone:978-921-0506
Practice Address - Fax:978-921-0129
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist