Provider Demographics
NPI:1093964694
Name:MERENDINA, FARRAH L (RPH)
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:L
Last Name:MERENDINA
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 1:449 PORTION RD
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4579
Mailing Address - Country:US
Mailing Address - Phone:631-737-1736
Mailing Address - Fax:631-737-2879
Practice Address - Street 1:449 PORTION RD
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4579
Practice Address - Country:US
Practice Address - Phone:631-737-1736
Practice Address - Fax:631-737-2879
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY47729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02607867Medicaid