Provider Demographics
NPI:1841244704
Name:ANGELO FRIELLO INC
Entity Type:Organization
Organization Name:ANGELO FRIELLO INC
Other - Org Name:PALMER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:518-762-8319
Mailing Address - Street 1:2 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2623
Mailing Address - Country:US
Mailing Address - Phone:518-762-8319
Mailing Address - Fax:518-762-5272
Practice Address - Street 1:2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2623
Practice Address - Country:US
Practice Address - Phone:518-762-8319
Practice Address - Fax:518-762-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0163933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0181230001OtherDMERC SUPPLIER NUMBER
NY3334240OtherNCPDP
NY00530218Medicaid
NY00530218Medicaid
NY00530218Medicaid