Provider Demographics
NPI:1619292646
Name:NUNZIATO, LISA (RPH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:NUNZIATO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16015 POWELLS COVE BLVD
Mailing Address - Street 2:APT D104
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1355
Mailing Address - Country:US
Mailing Address - Phone:917-270-8480
Mailing Address - Fax:
Practice Address - Street 1:160-15 POWELLS COVE BLVD
Practice Address - Street 2:D104
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357
Practice Address - Country:US
Practice Address - Phone:917-270-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist