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General NPI Number Information
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NPI Number | 1548406119
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Entity Type | Organization
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Legal Business Name | CLINICAL PHARMACY CONSULT, LLC
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Dates
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Enumeration Date | 01/01/2009
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Last Update Date | 01/09/2009
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Provider Practice Location Address
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Address Line | 134 EVELYN RD
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City | MINEOLA
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State | NY
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Zip | 11501-3206
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Country | US
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Telephone | 516-376-6412
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Fax |
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Provider Business Mailing Address
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Address Line | 734 FRANKLIN AVE #665
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City | GARDEN CITY
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State | NY
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Zip | 11530-4525
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Country | US
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Telephone | 516-376-6412
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | ROBERT KENNEDY AWADALLAH
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Credential | R.PH, MBA
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Telephone | 516-376-6412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 046732
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License Number State | NY
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