Healthcare Provider Details

I. General information

NPI: 1487941217
Provider Name (Legal Business Name): BRUCE C SNIPAS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6352 WOODHAVEN BLVD
REGO PARK NY
11374-2856
US

IV. Provider business mailing address

6352 WOODHAVEN BLVD
REGO PARK NY
11374-2856
US

V. Phone/Fax

Practice location:
  • Phone: 718-651-1000
  • Fax: 718-476-3776
Mailing address:
  • Phone: 718-651-1000
  • Fax: 718-476-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33864
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: