Basic Information
| Provider Information | |||||||||
| NPI: | 1164517645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANIELE | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | DOMINICK | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DANIELE | ||||||||
| OtherFirstName: | GREGORY | ||||||||
| OtherMiddleName: | DOMINICK | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RPH | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 181 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105951834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149484854 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2094 ALBANY POST RD | ||||||||
| Address2: | VA HUDSON VALLEY HCS PHARMACY | ||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105481454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 044913 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.