Provider Demographics
NPI:1124208764
Name:CAMPOREALE, JOSEPH M (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:CAMPOREALE
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 1:300 GRASMERE DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2848
Mailing Address - Country:US
Mailing Address - Phone:718-256-6774
Mailing Address - Fax:
Practice Address - Street 1:7009 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1603
Practice Address - Country:US
Practice Address - Phone:718-256-6774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist