Provider Demographics
NPI:1649582446
Name:DECARLO, EDMUND JOHN (PHARMD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:JOHN
Last Name:DECARLO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WILLS DR
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2847
Mailing Address - Country:US
Mailing Address - Phone:315-292-2999
Mailing Address - Fax:
Practice Address - Street 1:1503 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4709
Practice Address - Country:US
Practice Address - Phone:315-724-0125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05449901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist