Individual provider Active NPI

Anthony Sciullo, PHARMACIST

  • Pharmacist
  • Manchester, CT
National Provider Identifier
1528596038
Registry record updated May 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5602 Issued in CT
Practice address
286 Broad St
Manchester, CT 06040-4049
Phone
(860) 647-0325
Fax
(860) 647-0325
NPI assigned
May 28, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5602 CT Primary

Addresses

Primary practice location

286 Broad St
Manchester, CT 06040-4049

Mailing address

286 Broad St
Manchester, CT 06040-4049
Phone (860) 647-0325

Other identifiers 1

IdentifierTypeStateIssuer
004122438MedicaidCT

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495929600000",
    "number": "1528596038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "286 BROAD ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404049",
            "telephone_number": "860-647-0325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "286 BROAD ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404049",
            "telephone_number": "860-647-0325",
            "fax_number": "860-647-0325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCIULLO",
        "first_name": "ANTHONY",
        "credential": "PHARMACIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-28",
        "last_updated": "2017-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CT",
            "license": "5602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004122438",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.