Healthcare Provider Details

I. General information

NPI: 1609055110
Provider Name (Legal Business Name): RICHARD MIOLA R. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BROADWAY
GREENLAWN NY
11740-1310
US

IV. Provider business mailing address

15 CARAVAN DR
EAST NORTHPORT NY
11731-3816
US

V. Phone/Fax

Practice location:
  • Phone: 631-757-8200
  • Fax: 631-757-7656
Mailing address:
  • Phone: 631-368-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033824
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: