Provider Demographics
NPI:1417096793
Name:LEVIS, PETER E (RPH)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:E
Last Name:LEVIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1408
Mailing Address - Country:US
Mailing Address - Phone:718-267-8063
Mailing Address - Fax:718-267-8562
Practice Address - Street 1:3519 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1408
Practice Address - Country:US
Practice Address - Phone:718-267-8063
Practice Address - Fax:718-267-8562
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY041904OtherNYS LICENSE NUMBER