Provider Demographics
NPI:1629655915
Name:CONCOLINO, VERONICA ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ANN
Last Name:CONCOLINO
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 1:299 OLD TOWN RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2648
Mailing Address - Country:US
Mailing Address - Phone:631-793-2944
Mailing Address - Fax:
Practice Address - Street 1:161 CENTEREACH MALL
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2750
Practice Address - Country:US
Practice Address - Phone:631-467-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist