Provider Demographics
NPI:1508045857
Name:ZAMMILLO, RALPH THOMAS (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:THOMAS
Last Name:ZAMMILLO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CASCADE CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5316
Mailing Address - Country:US
Mailing Address - Phone:631-462-1410
Mailing Address - Fax:631-234-4054
Practice Address - Street 1:1968 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1514
Practice Address - Country:US
Practice Address - Phone:631-234-9417
Practice Address - Fax:631-234-4054
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist