Healthcare Provider Details

I. General information

NPI: 1407375025
Provider Name (Legal Business Name): NADINE DANDAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

8 BAY RIDGE AVE
BROOKLYN NY
11220-5086
US

V. Phone/Fax

Practice location:
  • Phone: 347-491-2729
  • Fax:
Mailing address:
  • Phone: 347-683-3389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number063459
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number063459
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: