Provider Demographics
NPI:1609385319
Name:BANGAREE, CLIFTON FREDERICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:FREDERICK
Last Name:BANGAREE
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 1:120 HANSON PL
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1747
Mailing Address - Country:US
Mailing Address - Phone:516-643-3939
Mailing Address - Fax:
Practice Address - Street 1:6352 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1350
Practice Address - Country:US
Practice Address - Phone:516-643-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist