Basic Information
| Provider Information | |||||||||
| NPI: | 1417279555 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUILLOT | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 WILDWOOD RD | ||||||||
| Address2: | |||||||||
| City: | RONKONKOMA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117795115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316766181 | ||||||||
| FaxNumber: | 6316766181 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 WALT WHITMAN RD | ||||||||
| Address2: | |||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117474107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315476520 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2010 | ||||||||
| LastUpdateDate: | 02/17/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 045603 | NY | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 045603 | 01 | NY | NY STATE LICENSE NUMBER | OTHER |