Provider Demographics
NPI:1962453282
Name:ROTELLA, GARY ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ANTHONY
Last Name:ROTELLA
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 1:45 REHM RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-1067
Mailing Address - Country:US
Mailing Address - Phone:716-681-5535
Mailing Address - Fax:
Practice Address - Street 1:6363 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1096
Practice Address - Country:US
Practice Address - Phone:716-601-0183
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist