Provider Demographics
NPI:1508188319
Name:FOX, ALLA (RPH)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1601
Mailing Address - Country:US
Mailing Address - Phone:516-887-3298
Mailing Address - Fax:
Practice Address - Street 1:1740 BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1601
Practice Address - Country:US
Practice Address - Phone:516-887-3298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-20
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist