Healthcare Provider Details

I. General information

NPI: 1912477316
Provider Name (Legal Business Name): HADASSAH OKOLICA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 N MAIN ST
NEW SQUARE NY
10977-8916
US

IV. Provider business mailing address

24 STONECREST DR
THIELLS NY
10984-1500
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-9320
  • Fax:
Mailing address:
  • Phone: 845-323-6605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number064633
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: