Provider Demographics
NPI:1366764755
Name:GELOSO, DAVID A (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:GELOSO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-2319
Mailing Address - Country:US
Mailing Address - Phone:315-254-3677
Mailing Address - Fax:
Practice Address - Street 1:1044 STATE STREET
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12307-0000
Practice Address - Country:US
Practice Address - Phone:518-344-7039
Practice Address - Fax:518-344-7086
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist