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General NPI Number Information
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NPI Number | 1407179914
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Entity Type | Individual
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Provider Name | ANTHONY MICHAEL MADDALENA JR. RPH.
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Gender | Male
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 785 MAMARONECK AVE
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City | WHITE PLAINS
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State | NY
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Zip | 10605-2523
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Country | US
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Telephone | 914-597-2203
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Fax | 914-597-2761
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Provider Business Mailing Address
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Address Line | 3360 SPRUCE ST
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City | MOHEGAN LAKE
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State | NY
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Zip | 10547-1411
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Country | US
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Telephone | 914-243-3697
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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 | 040169
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License Number State | NY
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