Provider Demographics
NPI:1467609289
Name:DOSSANTOS, AL (RPH)
Entity Type:Individual
Prefix:MR
First Name:AL
Middle Name:
Last Name:DOSSANTOS
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 1:1860 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3282
Mailing Address - Country:US
Mailing Address - Phone:516-822-6300
Mailing Address - Fax:516-822-6333
Practice Address - Street 1:1860 WALT WHITMAN RD
Practice Address - Street 2:SUITE 700
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3282
Practice Address - Country:US
Practice Address - Phone:516-822-6300
Practice Address - Fax:516-822-6333
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02700606Medicaid
NY02700606Medicaid