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General NPI Number Information
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NPI Number | 1346415197
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Entity Type | Individual
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Provider Name | MRS. MINERA DEVI PERSAUD
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Gender | Female
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 85 BUCKNELL RD
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City | VALLEY STREAM
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State | NY
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Zip | 11580-5326
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Country | US
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Telephone | 516-972-6637
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Fax | 516-972-6637
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Provider Business Mailing Address
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Address Line | 155 E 34TH ST
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City | NEW YORK
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State | NY
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Zip | 10016-4766
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Country | US
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Telephone | 212-683-3042
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Fax | 917-351-3669
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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 | 0044225
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License Number State | NY
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