Healthcare Provider Details

I. General information

NPI: 1215558150
Provider Name (Legal Business Name): SELENA DAGNINO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MORRIS AVE STE 2
BRONX NY
10451-4898
US

IV. Provider business mailing address

445 W 36TH ST APT 18
NEW YORK NY
10018-6315
US

V. Phone/Fax

Practice location:
  • Phone: 602-526-7975
  • Fax:
Mailing address:
  • Phone: 602-526-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number066494
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: