Provider Demographics
NPI:1518390269
Name:D'AMORE, PAUL M (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:D'AMORE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21914 MERRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1923
Mailing Address - Country:US
Mailing Address - Phone:718-712-7895
Mailing Address - Fax:718-712-7914
Practice Address - Street 1:21914 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-1923
Practice Address - Country:US
Practice Address - Phone:718-712-7895
Practice Address - Fax:718-712-7914
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist