Provider Demographics
NPI:1427275411
Name:GUGLIELMO, ANTHONY ROCCO
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ROCCO
Last Name:GUGLIELMO
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 1:3 BROOK DR
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1503
Mailing Address - Country:US
Mailing Address - Phone:631-689-5223
Mailing Address - Fax:
Practice Address - Street 1:1629 ISLIP AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2701
Practice Address - Country:US
Practice Address - Phone:631-234-6039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026640183500000X
NY26640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist