Provider Demographics
NPI:1578683538
Name:MATTELIANO, SALVATORE C (RPH)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:C
Last Name:MATTELIANO
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 1:52 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2414
Mailing Address - Country:US
Mailing Address - Phone:716-875-3934
Mailing Address - Fax:
Practice Address - Street 1:1740 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14223-1210
Practice Address - Country:US
Practice Address - Phone:716-874-5020
Practice Address - Fax:716-874-7815
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist