Provider Demographics
NPI:1376724666
Name:DINICOLANTONIO, CAROL JEAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JEAN
Last Name:DINICOLANTONIO
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 1:2 BLUEBIRD LN
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1024
Mailing Address - Country:US
Mailing Address - Phone:716-310-9144
Mailing Address - Fax:
Practice Address - Street 1:2 PARAGON DR
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1718
Practice Address - Country:US
Practice Address - Phone:201-571-8334
Practice Address - Fax:201-571-8335
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035366183500000X
FLPS22018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY035366OtherSTATE LICENSE
FLPS22018OtherSTATE LICENSE