Healthcare Provider Details

I. General information

NPI: 1659700169
Provider Name (Legal Business Name): NICHOLAS ANTHONY JANDOVITZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR PHARMACY DEPT
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

1633 LOWELL AVE
NEW HYDE PARK NY
11040-4301
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-4700
  • Fax:
Mailing address:
  • Phone: 516-695-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number058373
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: