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General NPI Number Information
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NPI Number | 1619145224
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Entity Type | Individual
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Provider Name | FREDERICK ANTHONY FEOLA R.PH.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2008
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Last Update Date | 02/16/2008
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Provider Practice Location Address
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Address Line | 1 SANGERTOWN SQ STE 3 TARGET T1492
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City | NEW HARTFORD
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State | NY
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Zip | 13413-1518
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Country | US
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Telephone | 315-738-9052
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Fax | 315-738-9052
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Provider Business Mailing Address
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Address Line | 6 SHERMAN PL
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City | CLINTON
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State | NY
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Zip | 13323-1410
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Country | US
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Telephone | 315-853-2735
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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 | 030149
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License Number State | NY
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