Healthcare Provider Details

I. General information

NPI: 1598948705
Provider Name (Legal Business Name): SANDRA K BILAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N RESEARCH PL T-2102
CENTRAL ISLIP NY
11722-4458
US

IV. Provider business mailing address

159 HORSEBLOCK RD
CENTEREACH NY
11720-4361
US

V. Phone/Fax

Practice location:
  • Phone: 631-297-2012
  • Fax:
Mailing address:
  • Phone: 631-880-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038682
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: