Provider Demographics
NPI:1285817460
Name:DEGIULIO, RICHARD J (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:DEGIULIO
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 1:393 WINGATE PL
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14174-1134
Mailing Address - Country:US
Mailing Address - Phone:716-745-7274
Mailing Address - Fax:
Practice Address - Street 1:220 PORTAGE RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1766
Practice Address - Country:US
Practice Address - Phone:716-405-7821
Practice Address - Fax:716-405-7824
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033260-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist