Provider Demographics
NPI:1467633198
Name:SIMONETTI, STEPHEN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:SIMONETTI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2542
Mailing Address - Country:US
Mailing Address - Phone:631-218-6880
Mailing Address - Fax:631-218-6887
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2542
Practice Address - Country:US
Practice Address - Phone:631-218-6880
Practice Address - Fax:631-218-6887
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist