Healthcare Provider Details

I. General information

NPI: 1386198299
Provider Name (Legal Business Name): ANDREW ALTOBELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 W KING ST
EAST BERLIN PA
17316-9730
US

IV. Provider business mailing address

PO BOX 1013
EAST BERLIN PA
17316-1013
US

V. Phone/Fax

Practice location:
  • Phone: 717-259-0421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number02849
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: