Provider Demographics
NPI:1679201453
Name:PETRILLO, ANTHONY (RPH)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:PETRILLO
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 1:103 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2201
Mailing Address - Country:US
Mailing Address - Phone:617-928-8455
Mailing Address - Fax:617-928-8456
Practice Address - Street 1:103 UNION ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2201
Practice Address - Country:US
Practice Address - Phone:617-928-8455
Practice Address - Fax:617-928-8456
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist