=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619746153
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTIAN CIARLO PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2023
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 387 WELLWOOD DR
-----------------------------------------------------
City | SHIRLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11967-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-316-2325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 85 CROOKED HILL RD
-----------------------------------------------------
City | COMMACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11725-5407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-316-2325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 071069
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------