Healthcare Provider Details

I. General information

NPI: 1366444804
Provider Name (Legal Business Name): JOHANNA GIOVANNIELLO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 01/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

8 PARIS ST
MILFORD CT
06460-7872
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax: 203-937-3403
Mailing address:
  • Phone: 203-876-8592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number046236
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: