Provider Demographics
NPI:1336218858
Name:ANGELO, GARY BRYANT (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:BRYANT
Last Name:ANGELO
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 1:1824 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8163
Mailing Address - Country:US
Mailing Address - Phone:732-255-3121
Mailing Address - Fax:732-255-3249
Practice Address - Street 1:1824 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8163
Practice Address - Country:US
Practice Address - Phone:732-255-3121
Practice Address - Fax:732-255-3249
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01287400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01287400OtherPHARMACY LICENSE REGISTRA