Provider Demographics
NPI:1053633966
Name:ANSALDO-CARBONELL, ANTONELLA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANTONELLA
Middle Name:
Last Name:ANSALDO-CARBONELL
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 1:350 PENNINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1204
Mailing Address - Country:US
Mailing Address - Phone:908-820-9823
Mailing Address - Fax:908-352-8808
Practice Address - Street 1:162 ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1148
Practice Address - Country:US
Practice Address - Phone:908-352-8808
Practice Address - Fax:908-352-5621
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02819700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist