1093894701 NPI number — MR. ANTHONY CARL STELLATO RPH

Table of content: MR. ANTHONY CARL STELLATO RPH (NPI 1093894701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093894701 NPI number — MR. ANTHONY CARL STELLATO RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STELLATO
Provider First Name:
ANTHONY
Provider Middle Name:
CARL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093894701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 VALLEY VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16345-4053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-757-9418
Provider Business Mailing Address Fax Number:
814-726-3716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 PENNSYLVANIA AVE E
Provider Second Line Business Practice Location Address:
THE MEDICINE SHOPPE
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16365-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-726-3741
Provider Business Practice Location Address Fax Number:
814-726-3716
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP033753L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RPI001147 . This is a "IMMUNIZING RPH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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