Provider Demographics
NPI:1174917801
Name:PELLICANO, ALBERT JOSEPH (BS OF PHARMACY)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:JOSEPH
Last Name:PELLICANO
Suffix:
Gender:M
Credentials:BS OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10861 WEYBURN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2957
Mailing Address - Country:US
Mailing Address - Phone:310-824-5013
Mailing Address - Fax:310-824-5719
Practice Address - Street 1:10861 WEYBURN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2957
Practice Address - Country:US
Practice Address - Phone:310-824-5013
Practice Address - Fax:310-824-5719
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist