MEDICARE: DR. CLIFTON FREDERICK BANGAREE 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
1	183500000X	Pharmacist	063136	NY

General Provider Information

NPI Number	:	1609385319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFTON FREDERICK BANGAREE PHARM.D

Provider Business Mailing Address
First Line	:	120 HANSON PL
Second Line	:
City	:	MALVERNE
State	:	NY
Zip	:	11565-1747
Country	:	US
Telephone Number	:	516-643-3939
Fax Number	:

Provider Business Practice Location Address
First Line	:	6352 108TH ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1350
Country	:	US
Telephone Number	:	516-643-3939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	06/16/2018

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