Provider Demographics
NPI:1013231661
Name:MAKOLIN, WILLIAM B (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:MAKOLIN
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 1:7701 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6607
Mailing Address - Country:US
Mailing Address - Phone:718-651-0795
Mailing Address - Fax:718-651-0054
Practice Address - Street 1:7701 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6607
Practice Address - Country:US
Practice Address - Phone:718-651-0795
Practice Address - Fax:718-651-0054
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist