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General NPI Number Information
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NPI Number | 1437946894
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Entity Type | Organization
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Legal Business Name | PROTERA SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 100 N CENTRE AVE STE 303
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-6300
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Country | US
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Telephone | 347-378-6489
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Fax | 718-732-2906
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Provider Business Mailing Address
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Address Line | 100 N CENTRE AVE STE 303
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-6300
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Country | US
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Telephone | 347-378-6489
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Fax | 718-732-2906
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Authorized Official
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Title or Position | CEO
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Name | JAQUELINE VOLMAN
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Credential |
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Telephone | 347-378-6459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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