Healthcare Provider Details

I. General information

NPI: 1376869701
Provider Name (Legal Business Name): ROBERT CASTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LAKE ST
STAMFORD NY
12167-1007
US

IV. Provider business mailing address

5 LAKE ST
STAMFORD NY
12167-1007
US

V. Phone/Fax

Practice location:
  • Phone: 607-652-3676
  • Fax: 607-431-2543
Mailing address:
  • Phone: 607-652-3675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number053498
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: