Provider Demographics
NPI:1073797056
Name:SHIFFRIN PINE, IRIS J (RPH)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:J
Last Name:SHIFFRIN PINE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5104
Mailing Address - Country:US
Mailing Address - Phone:718-251-7138
Mailing Address - Fax:
Practice Address - Street 1:1328 E 84TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5104
Practice Address - Country:US
Practice Address - Phone:718-251-7138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01979964Medicaid