Provider Demographics
NPI:1619658275
Name:CORRADINO, ANGELO (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:CORRADINO
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 1:1000 MEADE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3195
Mailing Address - Country:US
Mailing Address - Phone:570-345-9170
Mailing Address - Fax:
Practice Address - Street 1:1000 MEADE ST STE 104
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-3195
Practice Address - Country:US
Practice Address - Phone:570-345-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040731L1835C0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile Preparations