Provider Demographics
NPI:1114041654
Name:CALDERON, RENE RICARDO (RPH)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:RICARDO
Last Name:CALDERON
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 1:25501 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1223
Mailing Address - Country:US
Mailing Address - Phone:718-470-6100
Mailing Address - Fax:718-347-2043
Practice Address - Street 1:25501 UNION TPKE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1223
Practice Address - Country:US
Practice Address - Phone:718-470-6100
Practice Address - Fax:718-347-2043
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist