Provider Demographics
NPI:1740499680
Name:PEZZILLO, JOSEPHINE
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:
Last Name:PEZZILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1701
Mailing Address - Country:US
Mailing Address - Phone:516-801-2180
Mailing Address - Fax:
Practice Address - Street 1:790 PARK PLACE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2111
Practice Address - Country:US
Practice Address - Phone:516-536-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist