Provider Demographics
NPI:1114495652
Name:MARCELLO, SALVATORE ANTHONY (PHARM D)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:ANTHONY
Last Name:MARCELLO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7009
Mailing Address - Country:US
Mailing Address - Phone:718-983-7390
Mailing Address - Fax:
Practice Address - Street 1:955 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7009
Practice Address - Country:US
Practice Address - Phone:718-983-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY064925OtherPHARMACY LICENSE