Provider Demographics
NPI:1629255203
Name:HIDALGO, MARY GERALYNN (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:GERALYNN
Last Name:HIDALGO
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 1:182 S RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2813
Mailing Address - Country:US
Mailing Address - Phone:914-934-9619
Mailing Address - Fax:914-933-2716
Practice Address - Street 1:182 S RIDGE ST
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2813
Practice Address - Country:US
Practice Address - Phone:914-934-9619
Practice Address - Fax:914-933-2716
Is Sole Proprietor?:No
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01481167Medicaid