Provider Demographics
NPI:1619145224
Name:FEOLA, FREDERICK ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:ANTHONY
Last Name:FEOLA
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 1:6 SHERMAN PL
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1410
Mailing Address - Country:US
Mailing Address - Phone:315-853-2735
Mailing Address - Fax:
Practice Address - Street 1:1 SANGERTOWN SQ STE 3
Practice Address - Street 2:TARGET T1492
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1518
Practice Address - Country:US
Practice Address - Phone:315-738-9052
Practice Address - Fax:315-738-9052
Is Sole Proprietor?:No
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist