Provider Demographics
NPI:1619238458
Name:SASIADEK, GARY FRANK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:FRANK
Last Name:SASIADEK
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 1:8000 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11439-9000
Mailing Address - Country:US
Mailing Address - Phone:718-990-2000
Mailing Address - Fax:
Practice Address - Street 1:72 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-3147
Practice Address - Country:US
Practice Address - Phone:718-388-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist