Provider Demographics
NPI:1447626718
Name:AZZARELLO, VINCENT ROGER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ROGER
Last Name:AZZARELLO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 HARRISON HILL CT
Mailing Address - Street 2:
Mailing Address - City:DEATSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36022-2807
Mailing Address - Country:US
Mailing Address - Phone:830-299-9785
Mailing Address - Fax:
Practice Address - Street 1:1903 COBBS FORD RD
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7230
Practice Address - Country:US
Practice Address - Phone:334-365-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist