Provider Demographics
NPI:1487818092
Name:MAYO, HENRY WISE III (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:WISE
Last Name:MAYO
Suffix:III
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 1:322 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2719
Mailing Address - Country:US
Mailing Address - Phone:516-536-1520
Mailing Address - Fax:
Practice Address - Street 1:750 PARK PL
Practice Address - Street 2:CHEM RX
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2110
Practice Address - Country:US
Practice Address - Phone:516-536-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist