Provider Demographics
NPI:1518280908
Name:PELELLA, JOHN VINCENT (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:VINCENT
Last Name:PELELLA
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 1:290 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1579
Mailing Address - Country:US
Mailing Address - Phone:845-534-4345
Mailing Address - Fax:845-534-4048
Practice Address - Street 1:290 MAIN ST
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1579
Practice Address - Country:US
Practice Address - Phone:845-534-4345
Practice Address - Fax:845-534-4048
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist