Healthcare Provider Details

I. General information

NPI: 1326361833
Provider Name (Legal Business Name): SALVATORE CANNIZZARO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1891
US

IV. Provider business mailing address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1891
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5000
  • Fax: 718-363-6718
Mailing address:
  • Phone: 718-604-5000
  • Fax: 718-363-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0344561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: