Provider Demographics
NPI:1235683202
Name:NAZARO, REBECCA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:NAZARO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4556
Mailing Address - Country:US
Mailing Address - Phone:631-487-9840
Mailing Address - Fax:
Practice Address - Street 1:105 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11796-1810
Practice Address - Country:US
Practice Address - Phone:631-244-5752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061988-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist