Active NPI
Justin Colucci, PHARMD.
- Oncology Pharmacist
- Santa Rosa, CA
National Provider Identifier
1013792522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oncology Pharmacist
- License
- 64178
- Practice address
- 401 Bicentennial Way
Santa Rosa, CA 95403-2149 - Phone
- (707) 393-4119
- Fax
- (866) 296-6825
- NPI assigned
- Aug 31, 2023
- Last updated
- Aug 31, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oncology Pharmacist | 1835X0200X | 64178 | CA | Primary |
Addresses
Primary practice location
401 Bicentennial Way
Santa Rosa, CA 95403-2149
Mailing address
2120 Rachel Dr
Santa Rosa, CA 95401-6751
Phone (209) 329-0554
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64178 | CA | MD | Oncology Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693440000000",
"number": "1013792522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2120 RACHEL DR",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954016751",
"telephone_number": "209-329-0554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 BICENTENNIAL WAY",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954032149",
"telephone_number": "707-393-4119",
"fax_number": "866-296-6825"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLUCCI",
"first_name": "JUSTIN",
"name_prefix": "Dr.",
"credential": "PHARMD.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-31",
"last_updated": "2023-08-31",
"certification_date": "2023-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "1835X0200X",
"taxonomy_group": "",
"desc": "Pharmacist, Oncology",
"state": "CA",
"license": "64178",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.