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General NPI Number Information
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NPI Number | 1558873059
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Entity Type | Individual
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Provider Name | ALEA MANSOOR PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 1140 OLD COUNTRY RD
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City | RIVERHEAD
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State | NY
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Zip | 11901-2073
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Country | US
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Telephone | 631-727-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 954 OTSEGO CT
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-3944
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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 |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 063409
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License Number State | NY
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