Healthcare Provider Details

I. General information

NPI: 1609058940
Provider Name (Legal Business Name): MARIA A PINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 FRANCIS LEWIS BLVD
FLUSHING NY
11358-1146
US

IV. Provider business mailing address

1415 160TH ST
WHITESTONE NY
11357-2722
US

V. Phone/Fax

Practice location:
  • Phone: 718-352-7378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046134
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: