Provider Demographics
NPI:1184803538
Name:AZZARELLI, JOHN N (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:AZZARELLI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2914
Mailing Address - Country:US
Mailing Address - Phone:718-668-1451
Mailing Address - Fax:
Practice Address - Street 1:98 FOREST RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2914
Practice Address - Country:US
Practice Address - Phone:718-668-1451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0371071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist