Provider Demographics
NPI:1093894701
Name:STELLATO, ANTHONY CARL (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:CARL
Last Name:STELLATO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:PA
Mailing Address - Zip Code:16345-4053
Mailing Address - Country:US
Mailing Address - Phone:814-757-9418
Mailing Address - Fax:814-726-3716
Practice Address - Street 1:3 PENNSYLVANIA AVE E
Practice Address - Street 2:THE MEDICINE SHOPPE
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2526
Practice Address - Country:US
Practice Address - Phone:814-726-3741
Practice Address - Fax:814-726-3716
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033753L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARPI001147OtherIMMUNIZING RPH