Provider Demographics
NPI:1992284525
Name:ZOLLO, LOUIS A
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:A
Last Name:ZOLLO
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 1:8621 ROBERT FULTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2620
Mailing Address - Country:US
Mailing Address - Phone:410-953-4714
Mailing Address - Fax:410-953-5207
Practice Address - Street 1:3175 23RD ST STE 410
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4134
Practice Address - Country:US
Practice Address - Phone:800-350-8119
Practice Address - Fax:800-349-5058
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3336S0011XMedicaid
NY3336M0002XMedicaid