Healthcare Provider Details

I. General information

NPI: 1104174630
Provider Name (Legal Business Name): KELLY ANN DAMIANI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GREAT NECK RD
GREAT NECK NY
11021-3305
US

IV. Provider business mailing address

50 GREAT NECK RD
GREAT NECK NY
11021-3305
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-3050
  • Fax: 516-466-4804
Mailing address:
  • Phone: 516-466-3050
  • Fax: 516-466-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20057104
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: