Provider Demographics
NPI:1548797186
Name:PETRILLO, DAVID (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PETRILLO
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 1:30 WEXFORD ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2912
Mailing Address - Country:US
Mailing Address - Phone:888-633-6463
Mailing Address - Fax:844-633-6463
Practice Address - Street 1:30 WEXFORD ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2912
Practice Address - Country:US
Practice Address - Phone:888-633-6463
Practice Address - Fax:844-633-6463
Is Sole Proprietor?:No
Enumeration Date:2017-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH15760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist