Provider Demographics
NPI:1093996944
Name:GIANNINI, CHARLES ALBERTO (BS RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALBERTO
Last Name:GIANNINI
Suffix:
Gender:M
Credentials:BS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 LERER LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-2401
Mailing Address - Country:US
Mailing Address - Phone:718-966-3692
Mailing Address - Fax:718-966-3692
Practice Address - Street 1:1350 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7702
Practice Address - Country:US
Practice Address - Phone:212-695-6346
Practice Address - Fax:212-695-7651
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044977-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist