Provider Demographics
NPI:1871800672
Name:PRISCO, CARMINE EDWARD III (PHARM D)
Entity type:Individual
Prefix:
First Name:CARMINE
Middle Name:EDWARD
Last Name:PRISCO
Suffix:III
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MAIN ST STE 640
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5089
Mailing Address - Country:US
Mailing Address - Phone:866-319-8257
Mailing Address - Fax:617-806-8577
Practice Address - Street 1:350 MAIN ST STE 640
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5089
Practice Address - Country:US
Practice Address - Phone:866-319-8257
Practice Address - Fax:617-806-8577
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21403183500000X
MAPH233557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist