Healthcare Provider Details

I. General information

NPI: 1598527871
Provider Name (Legal Business Name): ZACHARY WILLIAM OQUENDO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 INDEPENDENCE PLZ
SELDEN NY
11784-2417
US

IV. Provider business mailing address

149 KESWICK DR
EAST ISLIP NY
11730-3507
US

V. Phone/Fax

Practice location:
  • Phone: 631-698-8500
  • Fax:
Mailing address:
  • Phone: 631-624-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number071053
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: