Provider Demographics
NPI:1376711838
Name:FARAG, DINA M (RPH)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:M
Last Name:FARAG
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 1:3453 MILBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-5172
Mailing Address - Country:US
Mailing Address - Phone:516-484-1414
Mailing Address - Fax:516-484-1371
Practice Address - Street 1:130 WHEATLEY PLZ
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1316
Practice Address - Country:US
Practice Address - Phone:516-484-1414
Practice Address - Fax:516-484-1371
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048930-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048930-1OtherLICENSE