Provider Demographics
NPI:1336323641
Name:TOMASULO, RICHARD JOHN (MS RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOHN
Last Name:TOMASULO
Suffix:
Gender:M
Credentials:MS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 FOREST LANE
Mailing Address - Street 2:
Mailing Address - City:CROMPOND
Mailing Address - State:NY
Mailing Address - Zip Code:10517
Mailing Address - Country:US
Mailing Address - Phone:914-603-3937
Mailing Address - Fax:914-686-2907
Practice Address - Street 1:210 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2901
Practice Address - Country:US
Practice Address - Phone:914-686-0005
Practice Address - Fax:914-686-2907
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist