Provider Demographics
NPI:1043495054
Name:SQUITIERI, ALFONSO J (RPH)
Entity type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:J
Last Name:SQUITIERI
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 1:76 FOXFIRE ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6180
Mailing Address - Country:US
Mailing Address - Phone:845-355-6808
Mailing Address - Fax:
Practice Address - Street 1:2904 ROUTE 6
Practice Address - Street 2:SUITES 8 & 9
Practice Address - City:SLATE HILL
Practice Address - State:NY
Practice Address - Zip Code:10973
Practice Address - Country:US
Practice Address - Phone:845-355-5555
Practice Address - Fax:845-355-2525
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037589-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01444233Medicaid