Provider Demographics
NPI:1265613764
Name:PANDOLFO, ROCCO ANTHONY (RPH)
Entity type:Individual
Prefix:MR
First Name:ROCCO
Middle Name:ANTHONY
Last Name:PANDOLFO
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 1:4765 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-6211
Mailing Address - Country:US
Mailing Address - Phone:315-736-6822
Mailing Address - Fax:315-736-6867
Practice Address - Street 1:4765 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-6211
Practice Address - Country:US
Practice Address - Phone:315-736-6822
Practice Address - Fax:315-736-6867
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist