Provider Demographics
NPI:1558667709
Name:DISTEFANO, SAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAL
Middle Name:
Last Name:DISTEFANO
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 1:127 S BROADWAY
Mailing Address - Street 2:ATT-PHARMACY-SAINT JOSEPH'S HOSPITAL
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4006
Mailing Address - Country:US
Mailing Address - Phone:914-378-7667
Mailing Address - Fax:914-378-7440
Practice Address - Street 1:127 S BROADWAY
Practice Address - Street 2:ATT-PHARMACY-SAINT JOSEPH'S HOSPITAL
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4006
Practice Address - Country:US
Practice Address - Phone:914-378-7667
Practice Address - Fax:914-378-7440
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY49667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist