Healthcare Provider Details

I. General information

NPI: 1871740894
Provider Name (Legal Business Name): MICHAEL JAMES HANCOCK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 BAYVILLE AVE
BAYVILLE NY
11709-1670
US

IV. Provider business mailing address

253 BAYVILLE AVE
BAYVILLE NY
11709-1670
US

V. Phone/Fax

Practice location:
  • Phone: 166-283-6405
  • Fax: 516-628-3657
Mailing address:
  • Phone: 516-628-3640
  • Fax: 516-628-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: