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General NPI Number Information
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NPI Number | 1376032037
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Entity Type | Individual
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Provider Name | MICHAEL JAMES CANNELLA
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Gender | Male
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 300 W 135TH ST
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City | NEW YORK
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State | NY
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Zip | 10030-2731
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Country | US
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Telephone | 212-491-6015
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Fax |
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Provider Business Mailing Address
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Address Line | 4559 195TH ST
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City | FLUSHING
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State | NY
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Zip | 11358-3525
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Country | US
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Telephone | 917-572-6930
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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 | 063141
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License Number State | NY
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