Provider Demographics
NPI:1124343223
Name:CAPPIELLO, PETER
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:CAPPIELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 DREW RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8776
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 E GREEN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5653
Practice Address - Country:US
Practice Address - Phone:607-882-9500
Practice Address - Fax:607-882-9503
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist