1114197977 NPI number — MS. MADELEINE FRANCES LAFRANO PHARMACIST

Table of content: MS. MADELEINE FRANCES LAFRANO PHARMACIST (NPI 1114197977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114197977 NPI number — MS. MADELEINE FRANCES LAFRANO PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAFRANO
Provider First Name:
MADELEINE
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114197977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 INDEPENDENCE PLZ
Provider Second Line Business Mailing Address:
KING KULLEN PHARMACY #38
Provider Business Mailing Address City Name:
SELDEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11784-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-698-8074
Provider Business Mailing Address Fax Number:
631-698-8523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 INDEPENDENCE PLZ
Provider Second Line Business Practice Location Address:
KING KULLEN PHARMACY #38
Provider Business Practice Location Address City Name:
SELDEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11784-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-698-8074
Provider Business Practice Location Address Fax Number:
631-698-8523
Provider Enumeration Date:
03/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  039979 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01417427 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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