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NPI Code Detail

MEDICARE: DOMINICK SPADA RPH PHARM D

MEDICARE: DOMINICK SPADA RPH PHARM D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist041741NY

General Provider Information

NPI Number : 1558693218
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINICK SPADA RPH PHARM D
Provider Business Mailing Address
First Line : 235 DONGAN HILLS AVE SUITE 2B
Second Line : OCEAN BREEZE HEALTHCARE
City : STATEN ISLAND
State : NY
Zip : 10305-1918
Country : US
Telephone Number : 800-219-5920
Fax Number : 800-219-5921
Provider Business Practice Location Address
First Line : 235 DONGAN HILLS AVE SUITE 2B
Second Line : OCEAN BREEZE HEALTHCARE
City : STATEN ISLAND
State : NY
Zip : 10305-1918
Country : US
Telephone Number : 800-219-5920
Fax Number : 800-219-5921
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2010
Last Update Date : 11/01/2017

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