MEDICARE: MR. GREGORY DALCOLLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	049331	NY

General Provider Information

NPI Number	:	1720259757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY DALCOLLO

Provider Business Mailing Address
First Line	:	4 CORNELL CT S
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-3002
Country	:	US
Telephone Number	:	516-315-1378
Fax Number	:

Provider Business Practice Location Address
First Line	:	286 W MAIN ST
Second Line	:
City	:	PATCHOGUE
State	:	NY
Zip	:	11772-3008
Country	:	US
Telephone Number	:	631-576-8141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	06/27/2016

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Directions to “ MR. GREGORY DALCOLLO ” Practice Location

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