Healthcare Provider Details

I. General information

NPI: 1902227770
Provider Name (Legal Business Name): CORRADO R CIURLEO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2013
Last Update Date: 12/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E 187TH ST
BRONX NY
10458-6803
US

IV. Provider business mailing address

705 E 187TH ST
BRONX NY
10458-6803
US

V. Phone/Fax

Practice location:
  • Phone: 718-364-6100
  • Fax: 718-365-6421
Mailing address:
  • Phone: 718-364-6100
  • Fax: 718-365-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: