Provider Demographics
NPI:1639673817
Name:CIALLELLA, GINA (RPH)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CIALLELLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 ROMA DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-5539
Mailing Address - Country:US
Mailing Address - Phone:215-817-5868
Mailing Address - Fax:
Practice Address - Street 1:1934 DELMAR DR
Practice Address - Street 2:
Practice Address - City:FOLCROFT
Practice Address - State:PA
Practice Address - Zip Code:19032-1401
Practice Address - Country:US
Practice Address - Phone:484-494-8899
Practice Address - Fax:484-494-5817
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037335L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist