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General NPI Number Information
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NPI Number | 1033431689
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Entity Type | Individual
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Provider Name | MR. MITCHELL ALLEN LAVENDA
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Gender | Male
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 1891 EASTERN PKWY
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City | BROOKLYN
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State | NY
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Zip | 11233-3290
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Country | US
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Telephone | 781-346-2506
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Fax |
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Provider Business Mailing Address
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Address Line | 4 EAST AVE
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City | SEA CLIFF
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State | NY
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Zip | 11579-2110
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Country | US
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Telephone | 516-801-4055
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 040191
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License Number State | NY
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