Provider Demographics
NPI:1942585039
Name:CANGIALOSI, PETE (RPH)
Entity Type:Individual
Prefix:MR
First Name:PETE
Middle Name:
Last Name:CANGIALOSI
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 1:4550 ATLANTIC AVE
Mailing Address - Street 2:B
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-1513
Mailing Address - Country:US
Mailing Address - Phone:800-834-8778
Mailing Address - Fax:888-834-4333
Practice Address - Street 1:4550 ATLANTIC AVE
Practice Address - Street 2:B
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-1513
Practice Address - Country:US
Practice Address - Phone:800-834-8778
Practice Address - Fax:888-834-4333
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist