Provider Demographics
NPI:1588848907
Name:BANGIT, MARIA TERESA SANTOS
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:SANTOS
Last Name:BANGIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA TERESA
Other - Middle Name:SANTOS
Other - Last Name:BANGIT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:400 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3356
Mailing Address - Country:US
Mailing Address - Phone:516-216-1155
Mailing Address - Fax:
Practice Address - Street 1:1963 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4994
Practice Address - Country:US
Practice Address - Phone:718-299-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0042800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist