Provider Demographics
NPI:1366518110
Name:FRIELLO, THOMAS MICHAEL
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:FRIELLO
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 1:260 WEMPLE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-4444
Mailing Address - Country:US
Mailing Address - Phone:518-762-6180
Mailing Address - Fax:518-762-5272
Practice Address - Street 1:2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2623
Practice Address - Country:US
Practice Address - Phone:518-762-8319
Practice Address - Fax:518-762-5272
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033305OtherSTATE LICENSE NUMBER
NY033305OtherSTATE LICENSE NUMBER