Healthcare Provider Details

I. General information

NPI: 1174837116
Provider Name (Legal Business Name): MR. STANLEY E MGBEOJIRIKWE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MS. STANISLAUS E MGBEOJIRIKWE

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8455 256TH ST
FLORAL PARK NY
11001-1001
US

IV. Provider business mailing address

8455 256TH ST
FLORAL PARK NY
11001-1001
US

V. Phone/Fax

Practice location:
  • Phone: 718-523-1442
  • Fax:
Mailing address:
  • Phone: 347-336-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040384
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: