Healthcare Provider Details

I. General information

NPI: 1013811314
Provider Name (Legal Business Name): ANDREW KOBREN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10718 37TH DR
CORONA NY
11368-4557
US

IV. Provider business mailing address

325 ALTESSA BLVD
MELVILLE NY
11747-5203
US

V. Phone/Fax

Practice location:
  • Phone: 718-639-4107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number072686
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: