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General NPI Number Information
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NPI Number | 1184511891
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Entity Type | Individual
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Provider Name | LOREAL FERNANDES RPH
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Gender | Female
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 644 W PUTNAM AVE
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City | GREENWICH
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State | CT
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Zip | 06830-6088
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Country | US
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Telephone | 203-422-2022
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Fax |
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Provider Business Mailing Address
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Address Line | 13329 BOSS ST
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City | OZONE PARK
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State | NY
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Zip | 11417-2618
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Country | US
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Telephone | 347-202-3130
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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 | 071175
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0015468
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License Number State | CT
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