Provider Demographics
NPI:1689126419
Name:MANCIAMELI, SANTO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SANTO
Middle Name:
Last Name:MANCIAMELI
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 1:3432 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1002
Mailing Address - Country:US
Mailing Address - Phone:718-231-1600
Mailing Address - Fax:
Practice Address - Street 1:3432 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1002
Practice Address - Country:US
Practice Address - Phone:718-231-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist