Provider Demographics
NPI:1396091096
Name:CARLO, JOHN ALAN (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:CARLO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:CARLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:736 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1687
Mailing Address - Country:US
Mailing Address - Phone:315-470-7631
Mailing Address - Fax:315-470-2609
Practice Address - Street 1:736 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1687
Practice Address - Country:US
Practice Address - Phone:315-470-7631
Practice Address - Fax:315-470-2609
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032303-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist