Provider Demographics
NPI:1750300232
Name:SPICOLA, CHARLES R (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:SPICOLA
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 1:10765 ROCKY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH COLLINS
Mailing Address - State:NY
Mailing Address - Zip Code:14111-9619
Mailing Address - Country:US
Mailing Address - Phone:716-337-3851
Mailing Address - Fax:
Practice Address - Street 1:845 MAIN RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9706
Practice Address - Country:US
Practice Address - Phone:716-951-7000
Practice Address - Fax:716-951-7185
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist