Healthcare Provider Details

I. General information

NPI: 1689101826
Provider Name (Legal Business Name): ANGELO FRIELLO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E MAIN ST
JOHNSTOWN NY
12095-2623
US

IV. Provider business mailing address

2 E MAIN ST
JOHNSTOWN NY
12095-2623
US

V. Phone/Fax

Practice location:
  • Phone: 518-762-8319
  • Fax: 518-762-5272
Mailing address:
  • Phone: 518-762-8319
  • Fax: 518-762-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number16393
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number16393
License Number StateNY

VIII. Authorized Official

Name: MR. JAMES C CARDILLO
Title or Position: OWNER/VICE PRESIDENT
Credential: CPA
Phone: 914-747-5004