Healthcare Provider Details

I. General information

NPI: 1104720580
Provider Name (Legal Business Name): ANDREA MOSQUERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

23 COLLINGWOOD RD
MARLBORO NJ
07746-1550
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-6954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number074497
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: