Healthcare Provider Details

I. General information

NPI: 1407039464
Provider Name (Legal Business Name): WILLIAM SCHWETZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 MERRICK RD
MASSAPEQUA PARK NY
11762-3728
US

IV. Provider business mailing address

5125 MERRICK RD
MASSAPEQUA PARK NY
11762-3728
US

V. Phone/Fax

Practice location:
  • Phone: 516-798-7676
  • Fax: 516-795-4059
Mailing address:
  • Phone: 516-798-7676
  • Fax: 516-795-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047949
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: