Provider Demographics
NPI:1275772147
Name:NALIBOFF, ANN R (MS, ,RPH)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:R
Last Name:NALIBOFF
Suffix:
Gender:F
Credentials:MS, ,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 S MIDDLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4643
Mailing Address - Country:US
Mailing Address - Phone:516-466-4665
Mailing Address - Fax:
Practice Address - Street 1:180 S MIDDLE NECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4643
Practice Address - Country:US
Practice Address - Phone:516-466-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0378011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist