Provider Demographics
NPI:1629288956
Name:CASSAGNOL, MANOUCHKATHE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MANOUCHKATHE
Middle Name:
Last Name:CASSAGNOL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BUTLER PL
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4652
Mailing Address - Country:US
Mailing Address - Phone:516-489-8126
Mailing Address - Fax:
Practice Address - Street 1:76 BUTLER PL
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4652
Practice Address - Country:US
Practice Address - Phone:516-489-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20-0509601835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy