Provider Demographics
NPI:1164745469
Name:POMERANZ, ALAN DAVID (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:DAVID
Last Name:POMERANZ
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 1:1617 PAULA CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2758
Mailing Address - Country:US
Mailing Address - Phone:516-993-5844
Mailing Address - Fax:
Practice Address - Street 1:2145 BELLMORE AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5607
Practice Address - Country:US
Practice Address - Phone:516-221-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY036789OtherLICENSE