Healthcare Provider Details

I. General information

NPI: 1770954190
Provider Name (Legal Business Name): GREGORY SCOTT ANDERSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 QUEENS BLVD ATTN: PHARMACY
LONG ISLAND CITY NY
11101-1725
US

IV. Provider business mailing address

3711 QUEENS BLVD ATTN: PHARMACY
LONG ISLAND CITY NY
11101-1725
US

V. Phone/Fax

Practice location:
  • Phone: 718-361-5100
  • Fax:
Mailing address:
  • Phone: 718-361-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number040413
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: