Healthcare Provider Details

I. General information

NPI: 1871590323
Provider Name (Legal Business Name): WILLIAM J TOMASULO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 BEACH CHANNEL DR
FAR ROCKAWAY NY
11691-1042
US

IV. Provider business mailing address

903 HELEN CT
NORTH BELLMORE NY
11710-1029
US

V. Phone/Fax

Practice location:
  • Phone: 718-734-2647
  • Fax:
Mailing address:
  • Phone: 516-221-4533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number027987
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: