Provider Demographics
NPI:1255574950
Name:SCORZIELLO, DOMINIC MARK (RPH)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:MARK
Last Name:SCORZIELLO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 LEONARD ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4148
Mailing Address - Country:US
Mailing Address - Phone:616-458-8300
Mailing Address - Fax:616-458-3691
Practice Address - Street 1:800 LEONARD ST NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4148
Practice Address - Country:US
Practice Address - Phone:616-458-8300
Practice Address - Fax:616-458-3691
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01836400183500000X
MI5302027977183500000X
RIRPH03294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist