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General NPI Number Information
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NPI Number | 1245408186
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Entity Type | Individual
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Provider Name | PATRICK F CARILLO RPH
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Gender | Male
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 759 ROUTE 15 SOUTH
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City | LAKE HOPATCONG
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State | NJ
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Zip | 07849
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Country | US
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Telephone | 973-663-0250
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Fax | 973-663-4062
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Provider Business Mailing Address
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Address Line | 35 HURON AVE
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City | WAYNE
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State | NJ
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Zip | 07470-4418
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI02076100
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License Number State | NJ
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