=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902027980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLARA RESTREPO RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 08/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 FULTON AVE STORE NO.1
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-539-2144
-----------------------------------------------------
Fax | 718-359-9780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 FULTON AVE STORE NO 1
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-539-2144
-----------------------------------------------------
Fax | 718-359-9780
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 044138
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 028273
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------