Healthcare Provider Details

I. General information

NPI: 1467633198
Provider Name (Legal Business Name): STEPHEN SIMONETTI PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2007
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MAIN ST
SAYVILLE NY
11782-2542
US

IV. Provider business mailing address

101 MAIN ST
SAYVILLE NY
11782-2542
US

V. Phone/Fax

Practice location:
  • Phone: 631-218-6880
  • Fax: 631-218-6887
Mailing address:
  • Phone: 631-218-6880
  • Fax: 631-218-6887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number031359
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: