Provider Demographics
NPI:1427231067
Name:PICARELLO, MARIO T (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:T
Last Name:PICARELLO
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 1:97 LOCKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1066
Mailing Address - Country:US
Mailing Address - Phone:914-528-2800
Mailing Address - Fax:914-528-9015
Practice Address - Street 1:3145 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1521
Practice Address - Country:US
Practice Address - Phone:914-525-2800
Practice Address - Fax:914-528-9015
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist