=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184058489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERICA WEINSTEIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2013
-----------------------------------------------------
Last Update Date | 10/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1983 MARCUS AVE SUITE C100
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11042-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-352-8548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1983 MARCUS AVE SUITE C100
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11042-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-352-8548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DISTRICT PHARMACY SUPERVISOR
-----------------------------------------------------
Name | MS. WEINSTEIN WEINSTEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-437-7802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 058512
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------