Provider Demographics
NPI:1164746830
Name:MONGELLI, LINDA MARIE
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARIE
Last Name:MONGELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 KATONAH AVE
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2148
Mailing Address - Country:US
Mailing Address - Phone:914-232-3200
Mailing Address - Fax:914-232-3505
Practice Address - Street 1:294 KATONAH AVE
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2148
Practice Address - Country:US
Practice Address - Phone:914-232-3200
Practice Address - Fax:914-232-3505
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035541-11835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy