Provider Demographics
NPI:1477875763
Name:CARMELLA, GERALD EUGENE
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:EUGENE
Last Name:CARMELLA
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 1:8 SILBURY HL
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9095
Mailing Address - Country:US
Mailing Address - Phone:717-517-7868
Mailing Address - Fax:
Practice Address - Street 1:3975 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-9025
Practice Address - Country:US
Practice Address - Phone:717-285-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027246L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist