Basic Information
| Provider Information | |||||||||
| NPI: | 1548406119 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLINICAL PHARMACY CONSULT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 734 FRANKLIN AVE | ||||||||
| Address2: | #665 | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115304525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163766412 | ||||||||
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| Practice Location | |||||||||
| Address1: | 134 EVELYN RD | ||||||||
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| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115013206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163766412 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/01/2009 | ||||||||
| LastUpdateDate: | 01/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | AWADALLAH | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | KENNEDY | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5163766412 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | R.PH, MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | 046732 | NY | Y | Suppliers | Pharmacy |
No ID Information.