Provider Demographics
NPI:1659520211
Name:FRASIOLAS, ANGELO (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:FRASIOLAS
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 1:530 W OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4112
Mailing Address - Country:US
Mailing Address - Phone:516-937-7172
Mailing Address - Fax:516-637-7178
Practice Address - Street 1:530 W OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4112
Practice Address - Country:US
Practice Address - Phone:516-937-7172
Practice Address - Fax:516-637-7178
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY47148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02519088Medicaid