Provider Demographics
NPI:1407178635
Name:OLIVA, IDANIA (RPH)
Entity Type:Individual
Prefix:
First Name:IDANIA
Middle Name:
Last Name:OLIVA
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 1:45 S SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4100
Mailing Address - Country:US
Mailing Address - Phone:800-522-0556
Mailing Address - Fax:800-880-9022
Practice Address - Street 1:45 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4100
Practice Address - Country:US
Practice Address - Phone:800-522-0556
Practice Address - Fax:800-880-9022
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036184-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist