Healthcare Provider Details

I. General information

NPI: 1790001493
Provider Name (Legal Business Name): ROSELLA PIRULLI MENTA R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 FOREST AVE
RYE NY
10580-3645
US

IV. Provider business mailing address

464 FOREST AVE
RYE NY
10580-3645
US

V. Phone/Fax

Practice location:
  • Phone: 914-967-0856
  • Fax: 914-967-1989
Mailing address:
  • Phone: 914-967-0856
  • Fax: 914-967-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 37818
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040435-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: