Healthcare Provider Details

I. General information

NPI: 1477736742
Provider Name (Legal Business Name): DINA KALANTAROVA R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WHITEHALL ST
NEW YORK NY
10004-2109
US

IV. Provider business mailing address

1 WHITEHALL ST
NEW YORK NY
10004-2109
US

V. Phone/Fax

Practice location:
  • Phone: 212-509-9020
  • Fax: 212-785-1779
Mailing address:
  • Phone: 212-509-9020
  • Fax: 212-785-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047196
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: