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General NPI Number Information
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NPI Number | 1578875597
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Entity Type | Organization
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Legal Business Name | JOSEPH GIANGIACOMO
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Dates
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Enumeration Date | 07/07/2010
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Last Update Date | 07/07/2010
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Provider Practice Location Address
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Address Line | 17 ROOSA AVE
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City | MONTICELLO
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State | NY
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Zip | 12701-1203
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Country | US
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Telephone | 845-794-9509
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Fax |
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Provider Business Mailing Address
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Address Line | 17 ROOSA AVE
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City | MONTICELLO
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State | NY
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Zip | 12701-1203
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Country | US
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Telephone | 845-794-9509
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Fax |
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Authorized Official
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Title or Position | OWNER/IMMUNIZER
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Name | JOSEPH W GIANGIACOMO
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Credential | RPH
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Telephone | 845-794-9509
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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 | 049284
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License Number State | NY
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