=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386828820
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON KORNREICH R.PH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2007
-----------------------------------------------------
Last Update Date | 12/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 852 2ND AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-983-1810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20-20 STEINWAY STREET 4B
-----------------------------------------------------
City | ASTORIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-439-8414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 047728
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------