Provider Demographics
NPI:1326324559
Name:GIANCOLA, CAROL A (RPH)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:GIANCOLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 E SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4717
Mailing Address - Country:US
Mailing Address - Phone:517-351-0249
Mailing Address - Fax:
Practice Address - Street 1:3435 E SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4717
Practice Address - Country:US
Practice Address - Phone:517-351-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027692183500000X
IL051028087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist