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General NPI Number Information
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NPI Number | 1619195898
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Entity Type | Organization
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Legal Business Name | WAKEFIELD PHARMACY INC.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 13525 LEFFERTS BLVD
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11420-3601
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Country | US
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Telephone | 718-843-3900
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Fax | 718-843-6044
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Provider Business Mailing Address
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Address Line | 13525 LEFFERTS BLVD
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11420-3601
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Country | US
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Telephone | 718-843-3900
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Fax | 718-843-6044
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. ROBERT THOMAS MASON
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Credential | RPH-BS-MS-PHARMD
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Telephone | 718-843-3900
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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 | 30920
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License Number State | NY
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