Provider Demographics
NPI:1104004456
Name:FRUSTIERI, ALAN CARL (RPH)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:CARL
Last Name:FRUSTIERI
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 1:300 W 23RD ST
Mailing Address - Street 2:APT. 3J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2210
Mailing Address - Country:US
Mailing Address - Phone:212-255-7339
Mailing Address - Fax:
Practice Address - Street 1:440 9TH AVE
Practice Address - Street 2:APT. 9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1620
Practice Address - Country:US
Practice Address - Phone:212-273-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1205852415OtherPHARMACY