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General NPI Number Information
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NPI Number | 1477876555
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Entity Type | Individual
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Provider Name | JONATHAN SCOTT PODLASKI PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 575 UNDERHILL BLVD SUITE 110
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City | SYOSSET
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State | NY
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Zip | 11791-3426
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Country | US
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Telephone | 855-794-6634
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Fax | 855-794-6635
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Provider Business Mailing Address
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Address Line | 19 THOMPSON PL
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City | LYNBROOK
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State | NY
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Zip | 11563-4022
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Country | US
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Telephone | 516-395-1925
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 053990
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License Number State | NY
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