Provider Demographics
NPI:1255653861
Name:PETRUZZELLI, GARY A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:PETRUZZELLI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 CENTER ST
Mailing Address - Street 2:BUILDING 2A 1ST FLOOR
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1702
Mailing Address - Country:US
Mailing Address - Phone:717-761-2490
Mailing Address - Fax:717-731-7268
Practice Address - Street 1:1800 CENTER ST
Practice Address - Street 2:BUILDING 2A 1ST FLOOR
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1702
Practice Address - Country:US
Practice Address - Phone:717-761-2490
Practice Address - Fax:717-731-7268
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP441870OtherPA PHARMACIST LICENSE #