Provider Demographics
NPI:1447575584
Name:LEVINE, MICHAEL BARRY
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BARRY
Last Name:LEVINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-9726
Mailing Address - Country:US
Mailing Address - Phone:518-475-1407
Mailing Address - Fax:
Practice Address - Street 1:84 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-9726
Practice Address - Country:US
Practice Address - Phone:518-475-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist