Healthcare Provider Details

I. General information

NPI: 1366764755
Provider Name (Legal Business Name): DAVID A GELOSO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 STATE STREET
SCHENECTADY NY
12307-0000
US

IV. Provider business mailing address

188 S 5TH AVE
ILION NY
13357-2319
US

V. Phone/Fax

Practice location:
  • Phone: 518-344-7039
  • Fax: 518-344-7086
Mailing address:
  • Phone: 315-254-3677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: