Provider Demographics
NPI:1598146367
Name:BARRETO, REYMOND O (PHARMD)
Entity Type:Individual
Prefix:
First Name:REYMOND
Middle Name:O
Last Name:BARRETO
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 1:46 THOMPSON SQUARE MALL
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-3220
Mailing Address - Country:US
Mailing Address - Phone:845-794-0237
Mailing Address - Fax:
Practice Address - Street 1:46 THOMPSON SQUARE MALL
Practice Address - Street 2:SHOPRITE PHARMACY
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701
Practice Address - Country:US
Practice Address - Phone:845-794-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY042684-1OtherPHARMACY LICENSE NUMBER
NY403417OtherNABP NUMBER