Provider Demographics
NPI:1336303510
Name:MCDADE, GINA I (RPH)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:I
Last Name:MCDADE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SPRING VALLEY MARKETPLACE
Mailing Address - Street 2:TARGET PHARMACY T1808
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5213
Mailing Address - Country:US
Mailing Address - Phone:845-371-5811
Mailing Address - Fax:
Practice Address - Street 1:50 SPRING VALLEY MARKETPLACE
Practice Address - Street 2:TARGET PHARMACY T1808
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5213
Practice Address - Country:US
Practice Address - Phone:845-371-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01735015Medicaid