Provider Demographics
NPI:1013230085
Name:GARTNER, DENNIS (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:GARTNER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-2307
Mailing Address - Country:US
Mailing Address - Phone:914-271-5000
Mailing Address - Fax:914-271-5001
Practice Address - Street 1:128 GRAND ST
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-2307
Practice Address - Country:US
Practice Address - Phone:914-271-5000
Practice Address - Fax:914-271-5001
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01255123Medicaid