Provider Demographics
NPI:1659405611
Name:GARCIA, MAYRA L (RPH)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:L
Last Name:GARCIA
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 1:811 BEVERLEY RD APT 3R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3322
Mailing Address - Country:US
Mailing Address - Phone:718-724-4520
Mailing Address - Fax:
Practice Address - Street 1:3950 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3802
Practice Address - Country:US
Practice Address - Phone:718-391-0400
Practice Address - Fax:718-391-0777
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist