Provider Demographics
NPI:1861724254
Name:JANNOTTE, ALFONSO LOUIS (RPH)
Entity type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:LOUIS
Last Name:JANNOTTE
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 1:8529 126TH ST
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3312
Mailing Address - Country:US
Mailing Address - Phone:718-850-5811
Mailing Address - Fax:718-849-6049
Practice Address - Street 1:8529 126TH ST
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3312
Practice Address - Country:US
Practice Address - Phone:718-850-5811
Practice Address - Fax:718-849-6049
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist