Healthcare Provider Details

I. General information

NPI: 1285959759
Provider Name (Legal Business Name): ALPHONSE A GENTILE JR. RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 STUYVESANT PL
STATEN ISLAND NY
10301-1917
US

IV. Provider business mailing address

99 STUYVESANT PL
STATEN ISLAND NY
10301-1917
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-0333
  • Fax:
Mailing address:
  • Phone: 718-447-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number024558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: