Provider Demographics
NPI:1043497944
Name:TRISTANO, ANTHONY J JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:TRISTANO
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:460 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4404
Mailing Address - Country:US
Mailing Address - Phone:631-422-1912
Mailing Address - Fax:631-893-0270
Practice Address - Street 1:460 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4404
Practice Address - Country:US
Practice Address - Phone:631-422-1912
Practice Address - Fax:631-893-0270
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist