Provider Demographics
NPI:1306023254
Name:STEFAS, ONISIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ONISIS
Middle Name:
Last Name:STEFAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILLOW PARK CENTER
Mailing Address - Street 2:TARGET STORE T-1866
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735
Mailing Address - Country:US
Mailing Address - Phone:631-962-0271
Mailing Address - Fax:631-962-0271
Practice Address - Street 1:100 WILLOW PARK CENTER
Practice Address - Street 2:TARGET STORE T-1866
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735
Practice Address - Country:US
Practice Address - Phone:631-962-0271
Practice Address - Fax:631-962-0271
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02334701Medicaid