Healthcare Provider Details

I. General information

NPI: 1376807982
Provider Name (Legal Business Name): ANGELO DEGUGLIELMO JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 AMSTERDAM AVE
NEW YORK NY
10024-2804
US

IV. Provider business mailing address

288 GROVE ST STE 300P
WORCESTER MA
01605-3934
US

V. Phone/Fax

Practice location:
  • Phone: 212-712-2821
  • Fax:
Mailing address:
  • Phone: 508-926-6850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2056785
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051290328
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPH232776
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH232776
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: