Provider Demographics
NPI:1053865253
Name:CRISANTOS, PORFIBERT (PHARMD)
Entity Type:Individual
Prefix:
First Name:PORFIBERT
Middle Name:
Last Name:CRISANTOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 6TH ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3665
Mailing Address - Country:US
Mailing Address - Phone:718-780-6844
Mailing Address - Fax:
Practice Address - Street 1:501 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3671
Practice Address - Country:US
Practice Address - Phone:718-780-7791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist