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General NPI Number Information
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NPI Number | 1124157060
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Entity Type | Individual
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Provider Name | MS. BONNIE CELESTE CREA
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1988 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-3526
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Country | US
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Telephone | 718-667-4300
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Fax | 718-980-2636
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Provider Business Mailing Address
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Address Line | 159 GREAT KILLS RD
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City | STATEN ISLAND
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State | NY
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Zip | 10308-2938
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Country | US
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Telephone | 718-667-4300
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Fax | 718-980-2636
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 030109089183903
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License Number State | NY
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