Provider Demographics
NPI:1598527871
Name:OQUENDO, ZACHARY WILLIAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:WILLIAM
Last Name:OQUENDO
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 1:149 KESWICK DR
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-3507
Mailing Address - Country:US
Mailing Address - Phone:631-624-3961
Mailing Address - Fax:
Practice Address - Street 1:229 INDEPENDENCE PLZ
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2417
Practice Address - Country:US
Practice Address - Phone:631-698-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI071053OtherIMMUNIZING PHARMACIST LICENSE