Provider Demographics
NPI:1821266040
Name:OLIVERI, CARLO (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARLO
Middle Name:
Last Name:OLIVERI
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 1:2 GRENVILLE CT
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1004
Mailing Address - Country:US
Mailing Address - Phone:516-599-3248
Mailing Address - Fax:
Practice Address - Street 1:1530 FRONT ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2241
Practice Address - Country:US
Practice Address - Phone:516-483-3256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032666OtherRPH STATE LICENSE NUMBER