Provider Demographics
NPI:1215558150
Name:DAGNINO, SELENA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SELENA
Middle Name:
Last Name:DAGNINO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 W 36TH ST APT 18
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-6315
Mailing Address - Country:US
Mailing Address - Phone:602-526-7975
Mailing Address - Fax:
Practice Address - Street 1:655 MORRIS AVE STE 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4898
Practice Address - Country:US
Practice Address - Phone:602-526-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist