Healthcare Provider Details

I. General information

NPI: 1194134171
Provider Name (Legal Business Name): TATIANA ANNE MERORES PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 04/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3199 LONG BEACH RD
OCEANSIDE NY
11572-4107
US

IV. Provider business mailing address

3199 LONG BEACH RD
OCEANSIDE NY
11572-4107
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-7200
  • Fax: 516-763-1426
Mailing address:
  • Phone: 516-766-7200
  • Fax: 516-763-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number059625
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: