Provider Demographics
NPI:1609198019
Name:REDMOND, MICHAEL WARREN (BS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WARREN
Last Name:REDMOND
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202-20 ROCKAWAY POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1113
Mailing Address - Country:US
Mailing Address - Phone:718-634-0273
Mailing Address - Fax:718-634-8842
Practice Address - Street 1:202-20 ROCKAWAY POINT BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY POINT
Practice Address - State:NY
Practice Address - Zip Code:11697-1113
Practice Address - Country:US
Practice Address - Phone:718-634-0273
Practice Address - Fax:718-634-8842
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist