Provider Demographics
NPI:1346757200
Name:SCHIAVONE, VITO ANTHONY
Entity Type:Individual
Prefix:
First Name:VITO
Middle Name:ANTHONY
Last Name:SCHIAVONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ARELAND DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-9539
Mailing Address - Country:US
Mailing Address - Phone:484-695-8422
Mailing Address - Fax:
Practice Address - Street 1:96 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1836
Practice Address - Country:US
Practice Address - Phone:908-454-4532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042313L183500000X
NJ28RI03898600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist