Provider Demographics
NPI:1033392345
Name:AIELLO, MARYJANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARYJANE
Middle Name:
Last Name:AIELLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 STAR RT 104 E
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2913
Mailing Address - Country:US
Mailing Address - Phone:315-343-4371
Mailing Address - Fax:315-343-2407
Practice Address - Street 1:293 STAR RT 104
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2946
Practice Address - Country:US
Practice Address - Phone:315-343-4371
Practice Address - Fax:315-343-2407
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00482848Medicaid