Provider Demographics
NPI:1437473162
Name:D'ANGELO, NICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:
Last Name:D'ANGELO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 PENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2549
Mailing Address - Country:US
Mailing Address - Phone:585-419-0560
Mailing Address - Fax:585-419-0552
Practice Address - Street 1:1659 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2549
Practice Address - Country:US
Practice Address - Phone:585-419-0560
Practice Address - Fax:585-419-0552
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054301183500000X
AZS017402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist