Provider Demographics
NPI:1033389176
Name:LEVANTI, JOSEPH MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:LEVANTI
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 1:1110 ROUTE 112
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3043
Mailing Address - Country:US
Mailing Address - Phone:631-474-2657
Mailing Address - Fax:631-474-9261
Practice Address - Street 1:1110 ROUTE 112
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3043
Practice Address - Country:US
Practice Address - Phone:631-474-2657
Practice Address - Fax:631-474-9261
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist