Provider Demographics
NPI:1407170053
Name:STELLA, ROCCO FRANK (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROCCO
Middle Name:FRANK
Last Name:STELLA
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 1:8722 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3412
Mailing Address - Country:US
Mailing Address - Phone:718-272-8450
Mailing Address - Fax:718-272-4279
Practice Address - Street 1:8722 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3412
Practice Address - Country:US
Practice Address - Phone:718-272-8450
Practice Address - Fax:718-272-4279
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI-22272-1183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01295138Medicaid
3306633OtherNAPB