Provider Demographics
NPI:1912540790
Name:ANELLI, GREGORI PETER
Entity Type:Individual
Prefix:
First Name:GREGORI
Middle Name:PETER
Last Name:ANELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6100
Mailing Address - Country:US
Mailing Address - Phone:570-459-5759
Mailing Address - Fax:570-459-6038
Practice Address - Street 1:300 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2815
Practice Address - Country:US
Practice Address - Phone:570-459-5759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041251L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist