Provider Demographics
NPI:1568680155
Name:SILVA, JERRY (RPH)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:SILVA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2594 NORTON PL
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5412
Mailing Address - Country:US
Mailing Address - Phone:516-785-8633
Mailing Address - Fax:
Practice Address - Street 1:750 PARK PL
Practice Address - Street 2:
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:516-889-8690
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021246OtherLICENSE NUMBER