Provider Demographics
NPI:1649597618
Name:MEZZETTA, JOHN ANGELO (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANGELO
Last Name:MEZZETTA
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 1:681 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2361
Mailing Address - Country:US
Mailing Address - Phone:516-799-5858
Mailing Address - Fax:516-799-3654
Practice Address - Street 1:681 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2361
Practice Address - Country:US
Practice Address - Phone:516-799-5858
Practice Address - Fax:516-799-3654
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035501-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist