Provider Demographics
NPI:1861782872
Name:BIANCARELLI, BRUCE A
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:BIANCARELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 CARBONDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18447-7715
Mailing Address - Country:US
Mailing Address - Phone:570-586-2749
Mailing Address - Fax:570-586-1759
Practice Address - Street 1:580 CARBONDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTT TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18447-7715
Practice Address - Country:US
Practice Address - Phone:570-586-2749
Practice Address - Fax:570-586-1759
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPO34441L183500000X
NY054352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist