Provider Demographics
NPI:1922286715
Name:RUTH, ANTONELLA (RPH)
Entity Type:Individual
Prefix:
First Name:ANTONELLA
Middle Name:
Last Name:RUTH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ANTONELLA
Other - Middle Name:
Other - Last Name:CONSIGLIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:140 PINE ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075
Mailing Address - Country:US
Mailing Address - Phone:716-649-9505
Mailing Address - Fax:716-649-9260
Practice Address - Street 1:140 PINE ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075
Practice Address - Country:US
Practice Address - Phone:716-649-9505
Practice Address - Fax:716-649-9260
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 041367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist