Healthcare Provider Details

I. General information

NPI: 1003859968
Provider Name (Legal Business Name): DAVID R RESTREPO PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 1ST AVE
NEW YORK NY
10021-6311
US

IV. Provider business mailing address

117 BARLOW DR S
BROOKLYN NY
11234-6721
US

V. Phone/Fax

Practice location:
  • Phone: 212-628-1110
  • Fax: 212-628-1117
Mailing address:
  • Phone: 347-782-1128
  • Fax: 718-265-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: