Provider Demographics
NPI:1518102623
Name:ANGAROLA, PETER R
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:R
Last Name:ANGAROLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:ANGAROLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1 CRUM ELBOW DR
Mailing Address - Street 2:PO BOX 234
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2105
Mailing Address - Country:US
Mailing Address - Phone:845-229-4312
Mailing Address - Fax:
Practice Address - Street 1:1 CRUM ELBOW DR
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-2105
Practice Address - Country:US
Practice Address - Phone:845-229-4312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist