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General NPI Number Information
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NPI Number | 1356719454
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Entity Type | Organization
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Legal Business Name | TARGET
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 500 W SUNRISE HWY
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City | VALLEY STREAM
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State | NY
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Zip | 11581-1001
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Country | US
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Telephone | 516-568-9275
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Fax |
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Provider Business Mailing Address
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Address Line | 500 W SUNRISE HWY
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City | VALLEY STREAM
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State | NY
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Zip | 11581-1001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. ANDRE TAYLOR-DOMVILLE JR.
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Credential |
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Telephone | 201-450-3990
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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 | 061081
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License Number State | NY
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