Provider Demographics
NPI:1356514061
Name:SANTORELLI, GINA MARIE (RPH)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:SANTORELLI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:AMBROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:15301 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1255
Mailing Address - Country:US
Mailing Address - Phone:718-767-0876
Mailing Address - Fax:718-747-3033
Practice Address - Street 1:15301 10TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1255
Practice Address - Country:US
Practice Address - Phone:718-767-0876
Practice Address - Fax:718-747-3033
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist