=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922551522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY ANGELINI RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2016
-----------------------------------------------------
Last Update Date | 07/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 555 ROUTE 88
-----------------------------------------------------
City | CARMICHAELS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15320-1173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-966-5237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 219 PUMPKIN RUN RD
-----------------------------------------------------
City | JEFFERSON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15344-4246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP032865L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------