Provider Demographics
NPI:1013199140
Name:MONIAS, SPIRO PETER (RPH)
Entity Type:Individual
Prefix:MR
First Name:SPIRO
Middle Name:PETER
Last Name:MONIAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 RINALDO RD
Mailing Address - Street 2:
Mailing Address - City:FORT SALONGA
Mailing Address - State:NY
Mailing Address - Zip Code:11768
Mailing Address - Country:US
Mailing Address - Phone:516-644-8400
Mailing Address - Fax:631-981-5225
Practice Address - Street 1:139 RONKONKOMA AVE
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3339
Practice Address - Country:US
Practice Address - Phone:631-981-4477
Practice Address - Fax:631-981-5225
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00658562Medicaid