Healthcare Provider Details

I. General information

NPI: 1235125287
Provider Name (Legal Business Name): VINCENT GIAMBANCO III RPH, MS, CGP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6193 NORTHERN BLVD
EAST NORWICH NY
11732-1615
US

IV. Provider business mailing address

6193 NORTHERN BLVD
EAST NORWICH NY
11732-1615
US

V. Phone/Fax

Practice location:
  • Phone: 516-922-0166
  • Fax:
Mailing address:
  • Phone: 516-922-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33313
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: