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General NPI Number Information
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NPI Number | 1851441232
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Entity Type | Individual
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Provider Name | BAKUL N MATALIA R.PH.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 126 E MAIN ST STE 4
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City | EAST ISLIP
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State | NY
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Zip | 11730-2600
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Country | US
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Telephone | 631-581-9620
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Fax | 631-581-9410
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Provider Business Mailing Address
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Address Line | 15 TWIN CT
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City | SAYVILLE
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State | NY
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Zip | 11782-1546
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Country | US
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Telephone | 631-567-7177
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Fax | 631-581-9410
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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 | 031828
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License Number State | NY
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