MEDICARE: MRS. DONNA MARIE SIRAGUSA RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	046351	NY

General Provider Information

NPI Number	:	1093995110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA MARIE SIRAGUSA RPH

Provider Business Mailing Address
First Line	:	16010 CROSSBAY BLVD
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-3423
Country	:	US
Telephone Number	:	718-845-1066
Fax Number	:	718-845-1354

Provider Business Practice Location Address
First Line	:	1111 PENNSYLVANIA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-9000
Country	:	US
Telephone Number	:	718-272-0346
Fax Number	:	718-257-5746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	08/06/2024

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